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Colonic perfusion assessment with indocyanine-green fluorescence imaging in anterior resections: a propensity score-matched analysis

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Abstract

Background

Colonic perfusion is crucial for anastomotic healing and this could be evaluated intraoperatively using indocyanine-green fluorescence imaging (ICG FI). The aim of this study was to ascertain whether the use of ICG FI resulted in the reduction of anastomotic complications, i.e. AL and anastomotic stricture.

Methods

Consecutive patients who underwent anterior resections or low anterior resections at our institution in the period from January 1st 2013 to December 31st 2018 were retrospectively reviewed. Surgery performed during the period from January 1st 2013 to December 31st 2015 did not involve the use of ICG FI (ICG−) while surgery during the period from January 1st 2016 to December 31st 2018 was performed with the use of ICG FI (ICG+). The anastomotic leakage rates of the two groups were compared after propensity score matching, taking into account the height of the anastomosis and any history of pelvic irradiation.

Results

There was a total of 258 and 317 patients who had surgery with and without ICG FI, respectively. There were 253 patients in each group after propensity score matching. The overall anastomotic leakage rate was 3.6% and 7.9% for ICG+ and ICG−, respectively, (p = 0.035). Subgroup analysis showed that the use of ICG FI was significantly associated with a lower anastomotic leakage rate in total mesorectal excision (TME), 4.7% versus 11.6%, p = 0.043, but not in non-TME resections, 3.5% versus 2.4%, (p = 0.612). ICG FI, together with sex and anastomotic height, were independent predictors of anastomotic leakage.

Conclusions

The routine use of ICG FI was associated with a lower anastomotic leakage rate in anterior resections. The reduction in anastomotic leakage rate was mainly seen in TME.

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Funding

The authors report no external funding for this study.

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Authors and Affiliations

  1. Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China

    Chi Chung Foo & Wai Lun Law

  2. Department of Surgery, Queen Mary Hospital, Hong Kong, China

    Ka Kin Ng, Julian Tsang, Rockson Wei, Felix Chow, Toi Yin Chan & Oswens Lo

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  1. Chi Chung Foo
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  2. Ka Kin Ng
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  7. Oswens Lo
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Contributions

All authors contributed to the study conception and design. CCF: conception of work, acquisition of data, data analysis, drafting of manuscript, final approval. KKN: conception of work, data analysis, drafting of manuscript, final approval. JT: acquisition of data, interpretation of data, revising manuscript, final approval. RW: acquisition of data, drafting of manuscript, final approval. FC: conception of work, acquisition of data, revising manuscript, final approval. TYC: conception of work, interpretation of data, drafting of manuscript, final approval. OL: conception of work, interpretation of data, acquisition of data, revising manuscript, final approval. WLL: conception of work, revising of manuscript, final approval. The first draft of the manuscript was written by CCF and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Chi Chung Foo.

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The authors declare no conflict of interests.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Institutional review board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster approved this study.

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Foo, C.C., Ng, K.K., Tsang, J. et al. Colonic perfusion assessment with indocyanine-green fluorescence imaging in anterior resections: a propensity score-matched analysis. Tech Coloproctol 24, 935–942 (2020). https://doi.org/10.1007/s10151-020-02232-7

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  • DOI: https://doi.org/10.1007/s10151-020-02232-7

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