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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 3/2020

01-03-2020 | Angiography | Original Article

Impact of intraoperative indocyanine green fluorescence angiography on anastomotic leakage after laparoscopic sphincter-sparing surgery for malignant rectal tumors

Authors: Hiro Hasegawa, Yuichiro Tsukada, Masashi Wakabayashi, Shogo Nomura, Takeshi Sasaki, Yuji Nishizawa, Koji Ikeda, Tetsuo Akimoto, Masaaki Ito

Published in: International Journal of Colorectal Disease | Issue 3/2020

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Abstract

Purpose

Whether indocyanine green fluorescence angiography (ICG-FA) during rectal surgery is effective in reducing anastomotic leakage remains unclear. This study aimed to investigate the effect of intraoperative ICG-FA on anastomotic leakage after sphincter-sparing surgery for malignant rectal tumors.

Methods

This was a retrospective, single-center cohort study conducted on 852 consecutive patients who underwent laparoscopic sphincter-sparing surgery from January 2007 to June 2017 at our institution. The incidence of anastomotic leakage was compared between patients who underwent ICG-FA to determine the proximal resection margin and those in whom this technique was not performed, using logistic regression analysis, including propensity score.

Results

A total of eight patients were excluded (one patient with previous low anterior resection and seven patients who underwent simultaneous resection for other primary cancers), resulting in 844 patients being analyzed. Before propensity score matching, 141 patients (16.7%) who underwent ICG-FA were compared with 703 patients (83.3%) in whom ICG-FA was not performed. The incidence of anastomotic leakage was 2.8% (4/141) in the ICG-FA group and 12.4% (87/703) in the control group (p = 0.001). After propensity score matching (n = 420), the patient characteristics between the two groups were well balanced, and the incidence of anastomotic leakage was 2.8% (4/141) in the ICG-FA group and 13.6% (38/279) in the control group (p = 0.001). Logistic regression analyses using propensity score showed that patients who underwent ICG-FA had significantly lower odds of anastomotic leakage.

Conclusion

Intraoperative ICG-FA is a promising method to reduce anastomotic leakage after laparoscopic rectal surgery.
Appendix
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Metadata
Title
Impact of intraoperative indocyanine green fluorescence angiography on anastomotic leakage after laparoscopic sphincter-sparing surgery for malignant rectal tumors
Authors
Hiro Hasegawa
Yuichiro Tsukada
Masashi Wakabayashi
Shogo Nomura
Takeshi Sasaki
Yuji Nishizawa
Koji Ikeda
Tetsuo Akimoto
Masaaki Ito
Publication date
01-03-2020
Publisher
Springer Berlin Heidelberg
Keyword
Angiography
Published in
International Journal of Colorectal Disease / Issue 3/2020
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-019-03490-0

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