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Surgical Endoscopy
Published in: Surgical Endoscopy 5/2019

Open Access 01-05-2019 | 2018 SAGES Oral

Quantitative analysis of colon perfusion pattern using indocyanine green (ICG) angiography in laparoscopic colorectal surgery

Authors: Gyung Mo Son, Myeong Sook Kwon, Yoonhong Kim, Jisu Kim, Seung Hwa Kim, Jung Woo Lee

Published in: Surgical Endoscopy | Issue 5/2019

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Abstract

Purpose

This study aimed to quantitatively evaluate colon perfusion patterns using indocyanine green (ICG) angiography to find the most reliable predictive factor of anastomotic complications after laparoscopic colorectal surgery.

Methods

Laparoscopic fluorescence imaging was applied to colorectal cancer patients (n = 86) from July 2015 to December 2017. ICG (0.25 mg/kg) was slowly injected into peripheral blood vessels, and the fluorescence intensity of colonic flow was measured sequentially, producing perfusion graphs using a video analysis and modeling tool. Colon perfusion patterns were categorized as either fast, moderate, or slow based on their fluorescence slope, T1/2MAX and time ratio (TR = T1/2MAX/TMAX). Clinical factors and quantitative perfusion factors were analyzed to identify predictors for anastomotic complications.

Results

The mean age of patients was 65.4 years, and the male-to-female ratio was 63:23. Their operations were laparoscopic low anterior resection (55 cases) and anterior resection (31 cases). The incidence of anastomotic complication was 7%, including colonic necrosis (n = 1), anastomotic leak (n = 3), delayed pelvic abscess (n = 1), and delayed anastomotic dehiscence (n = 1). Based on quantitative analysis, the fluorescence slope, T1/2MAX, and TR were related with anastomotic complications. The cut-off value of TR to categorize the perfusion pattern was determined to be 0.6, as shown by ROC curve analysis (AUC 0.929, P < 0.001). Slow perfusion (TR > 0.6) was independent factor for anastomotic complications in a logistic regression model (OR 130.84; 95% CI 6.45–2654.75; P = 0.002). Anastomotic complications were significantly correlated with the novel factor TR (> 0.6) as the most reliable predictor of perfusion and anastomotic complications.

Conclusions

Quantitative analysis of ICG perfusion patterns using T1/2MAX and TR can be applied to detect segments with poor perfusion, thereby reducing anastomotic complications during laparoscopic colorectal surgery.
Literature
1.
Lange MM, Buunen M, Cornelis JH. van de Velde JFL (2008) Level of arterial ligation in rectal cancer surgery: low tie preferred over high tie. A review. Dis Colon Rectum 51:1139–1145CrossRefPubMedPubMedCentral
2.
Bonnet S, Berger A, Hentati N, Abid B, Chevallier JM, Wind P, Delmas V, Douard R (2012) High tie versus low tie vascular ligation of the inferior mesenteric artery in colorectal cancer surgery: impact on the gain in colon length and implications on the feasibility of anastomoses. Dis Colon Rectum 55:515CrossRef
3.
McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC (2015) Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg 102:462–479CrossRef
4.
Shogan BD, Carlisle EM, Alverdy JC, Umanskiy K (2013) Do we really know why colorectal anastomoses leak? J Gastrointest Surg 17:1698–1707CrossRef
5.
Masoni L, Mari FS, Nigri G, Favi F, Gasparrini M, Dall’Oglio A, Pindozzi F, Pancaldi A, Brescia A (2013) Preservation of the inferior mesenteric artery via laparoscopic sigmoid colectomy performed for diverticular disease: real benefit or technical challenge: a randomized controlled clinical trial. Surg Endosc 27:199–206CrossRefPubMed
6.
Watanabe J, Ota M, Suwa Y, Suzuki S, Suwa H, Momiyama M, Ishibe A, Watanabe K, Masui H, Nagahori K, Ichikawa Y, Endo I (2015) Evaluation of the intestinal blood flow near the rectosigmoid junction using the indocyanine green fluorescence method in a colorectal cancer surgery. Int J Colorectal Dis 30:329–335CrossRefPubMed
7.
Ris F, Buchs NC, Morel P, Mortensen NJ, Hompes R (2015) Discriminatory influence of Pinpoint perfusion imaging on diversion ileostomy after laparoscopic low anterior resection. Colorectal Dis 3:29–31CrossRef
8.
Vignali A, Gianotti L, Braga M, Radaelli G, Malvezzi L, Di Carlo V (2000) Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak. Dis Colon Rectum 43:76–82CrossRef
9.
Blumetti J, Chaudhry V, Cintron JR, Park JJ, Marecik S, Harrison JL, Prasad LM, Abcarian H (2014) Management of anastomotic leak: lessons learned from a large colon and rectal surgery training program. World J Surg 38:985–991CrossRefPubMed
10.
Kudszus S, Roesel C, Schachtrupp A, Hoer JJ (2010) Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage. Langenbecks Arch Surg 395:1025–1030CrossRef
11.
Boni L, David G, Dionigi G, Rausei S, Cassinotti E, Fingerhut A (2016) Indocyanine green-enhanced fluorescence to assess bowel perfusion during laparoscopic colorectal resection. Surg Endosc 30:2736–2742CrossRefPubMed
12.
James DR, Ris F, Yeung TM, Kraus R, Buchs NC, Mortensen NJ, Hompes RJ (2015) Fluorescence angiography in laparoscopic low rectal and anorectal anastomoses with pinpoint perfusion imaging–a critical appraisal with specific focus on leak risk reduction. Colorectal Dis 3:16–21CrossRef
13.
Foppa C, Denoya PI, Tarta C, Bergamaschi R (2014) Indocyanine green fluorescent dye during bowel surgery: are the blood supply “guessing days” over? Tech Coloproctol 18:753–758CrossRefPubMed
14.
Daskalaki D, Aguilera F, Patton K, Giulianotti PC (2015) Fluorescence in robotic surgery. J Surg Oncol 112:250–256CrossRef
15.
Ryu SJ, Masashi Y, Ohdaira H, Nobuhiro T, Norihiko S, Eisaku I, Keigo N, Satoru Y, Masaki K, Yutaka S (2016) Intraoperative ICG fluorescence contrast imaging of the main artery watershed area in colorectal cancer surgery: report of a case. Int J Surg Case Rep 26:176–178CrossRefPubMedPubMedCentral
16.
Degett TH, Andersen HS, Gogenur I (2016) Indocyanine green fluorescence angiography for intraoperative assessment of gastrointestinal anastomotic perfusion: a systematic review of clinical trials. Langenbecks Arch Surg 401:767–775CrossRefPubMed
17.
Kin C, Vo H, Welton L, Welton M (2015) Equivocal effect of intraoperative fluorescence angiography on colorectal anastomotic leaks. Dis Colon Rectum 58:582–587CrossRefPubMed
18.
Jafari MD, Wexner SD, Martz JE, McLemore EC, Margolin DA, Sherwinter DA, Lee SW, Senagore AJ, Phelan MJ, Stamos MJ (2015) Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg 220:82–92CrossRefPubMed
19.
Blanco-Colino R, Espin-Basany E (2018) Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Tech Coloproctol 22:15–23CrossRefPubMed
20.
Kim JC, Lee JL, Park SH (2017) Interpretative guidelines and possible indications for indocyanine green fluorescence imaging in robot-assisted sphincter-saving operations. Dis Colon Rectum 60:376–384CrossRefPubMed
21.
Kamiya K, Unno N, Miyazaki S, Sano M, Kikuchi H, Hiramatsu Y, Ohta M, Yamatodani T, Mineta H, Konno H (2015) Quantitative assessment of the free jejunal graft perfusion. J Surg Res 2194:394–399CrossRef
22.
Protyniak B, Dinallo AM, Boyan WP Jr, Dressner RM, Arvanitis ML (2015) Intraoperative indocyanine green fluorescence angiography: an objective evaluation of anastomotic perfusion in colorectal surgery. Am Surg 81:580–584PubMed
23.
Wada T, Kawada K, Takahashi R, Yoshitomi M, Hida K, Hasegawa S, Sakai Y (2017) ICG fluorescence imaging for quantitative evaluation of colonic perfusion in laparoscopic colorectal surgery. Surg Endosc 31:4184–4193CrossRef
24.
25.
Kim JC, Lee JL, Yoon YS, Alotaibi AM, Kim J (2016) Utility of indocyanine-green fluorescent imaging during robot-assisted sphincter-saving surgery on rectal cancer patients. Int J Med Robot 12:710–717CrossRefPubMed
26.
Hinoi T, Okajima M, Shimomura M, Egi H, Ohdan H, Konishi F, Sugihara K, Watanabe M (2013) Effect of left colonic artery preservation on anastomotic leakage in laparoscopic anterior resection for middle and low rectal cancer. World J Surg 37:2935–2943CrossRef
27.
Son GM, Park BS (2015) Internal diameter of left colic artery as predictor for the fluctuation of marginal arterial pressure after high ligation of IMA during rectal cancer surgery. Colorectal Dis 2:22–37
28.
Guo Y, Wang D, He L, Zhang Y, Zhao S, Zhang L, Sun X, Suo J (2017) Marginal artery stump pressure in left colic artery-preserving rectal cancer surgery: a clinical trial. ANZ J Surg 87:576–581CrossRefPubMed
29.
Hellan M, Spinoglio G, Pigazzi A, Lagares-Garcia JA (2014) The influence of fluorescence imaging on the location of bowel transection during robotic left-sided colorectal surgery. Surg Endosc 28:1695–1702CrossRefPubMed
30.
Nachiappan S, Askari A, Currie A, Kennedy RH, Faiz O (2014) Intraoperative assessment of colorectal anastomotic integrity: a systematic review. Surg Endosc 28:2513–2530CrossRef
31.
Sherwinter DA, Gallagher J, Donkar T (2013) Intra-operative transanal near infrared imaging of colorectal anastomotic perfusion: a feasibility study. Colorectal Dis 15:91–96CrossRefPubMed
32.
Grone J, Koch D, Kreis ME (2015) Impact of intraoperative microperfusion assessment with Pinpoint Perfusion Imaging on surgical management of laparoscopic low rectal and anorectal anastomoses. Colorectal Dis 3:22–28CrossRef
33.
Diana M, Noll E, Diemunsch P, Dallemagne B, Benahmed MA, Agnus V, Soler L, Barry B, Namer IJ, Demartines N, Charles AL, Geny B, Marescaux J (2014) Enhanced-reality video fluorescence: a real-time assessment of intestinal viability. Ann Surg 259:700–707CrossRefPubMed
34.
Ashitate Y, Vooght CS, Hutteman M, Oketokoun R, Choi HS, Frangioni JV (2012) Simultaneous assessment of luminal integrity and vascular perfusion of the gastrointestinal tract using dual-channel near-infrared fluorescence. Mol Imaging 11:301–308CrossRefPubMedPubMedCentral
35.
Asari SA, Cho MS, Kim NK (2015) Safe anastomosis in laparoscopic and robotic low anterior resection for rectal cancer: a narrative review and outcomes study from an expert tertiary center. Eur J Surg Oncol 41:175–185CrossRefPubMed
36.
Ris F, Hompes R, Cunningham C, Lindsey I, Guy R, Jones O, George B, Cahill RA, Mortensen NJ (2014) Near-infrared (NIR) perfusion angiography in minimally invasive colorectal surgery. Surg Endosc 28:2221–2226CrossRefPubMedPubMedCentral
Metadata
Title
Quantitative analysis of colon perfusion pattern using indocyanine green (ICG) angiography in laparoscopic colorectal surgery
Authors
Gyung Mo Son
Myeong Sook Kwon
Yoonhong Kim
Jisu Kim
Seung Hwa Kim
Jung Woo Lee
Publication date
01-05-2019
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 5/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-6439-y

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