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Surgical Endoscopy
Published in: Surgical Endoscopy 11/2019

Open Access 01-11-2019 | Hemicolectomy

Near-infrared fluorescence image-guidance in anastomotic colorectal cancer surgery and its relation to serum markers of anastomotic leakage: a clinical pilot study

Authors: Jacqueline van den Bos, Audrey C. H. M. Jongen, Jarno Melenhorst, Stéphanie O. Breukink, Kaatje Lenaerts, Rutger M. Schols, Nicole D. Bouvy, Laurents P. S. Stassen

Published in: Surgical Endoscopy | Issue 11/2019

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Abstract

Objective

Near-infrared fluorescence (NIRF) imaging using indocyanine green (ICG) might help reduce anastomotic leakage (AL) after colorectal surgery. This pilot study aims to analyze whether a relation exists between measured fluorescence intensity (FI) and postoperative inflammatory markers of AL, C-reactive protein (CRP), Intestinal fatty-acid binding protein (I-FABP), and calprotectin, to AL, in order to evaluate the potential of FI to objectively predict AL.

Methods

Patients scheduled for anastomotic colorectal cancer surgery were eligible for inclusion in this prospective pilot study. During surgery, at three time points (after bowel devascularization; before actual transection; after completion of anastomosis) a bolus of 0.2 mg/kg ICG was administered intravenously for assessment of bowel perfusion. FI was scored in scale from 1 to 5 based on the operating surgeon’s judgment (1 = no fluorescence visible, 5 = maximum fluorescent signal). The complete surgical procedure was digitally recorded. These recordings were used to measure FI postoperatively using OsiriX imaging software. Serum CRP, I-FABP, and calprotectin values were determined before surgery and on day 1, 3, and 5 postoperative; furthermore, the occurrence of AL was recorded.

Results

Thirty patients (n = 19 males; mean age 67 years; mean BMI 27.2) undergoing either laparoscopic or robotic anastomotic colorectal surgery were included. Indication for surgery was rectal—(n = 10), rectosigmoid—(n = 2), sigmoid—(n = 10), or more proximal colon carcinomas (n = 8). Five patients (16.7%) developed AL (n = 2 (6.6%) grade C according to the definition of the International Study group of Rectal Cancer). In patients with AL, the maximum fluorescence score was given less often (P = 0.02) and a lower FI compared to background FI was measured at 1st assessment (P = 0.039). However, no relation between FI and postoperative inflammatory parameters could be found.

Conclusion

Both subjective and measured FI seem to be related to AL. In this study, no relation between FI and inflammatory serum markers could yet be found.
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Metadata
Title
Near-infrared fluorescence image-guidance in anastomotic colorectal cancer surgery and its relation to serum markers of anastomotic leakage: a clinical pilot study
Authors
Jacqueline van den Bos
Audrey C. H. M. Jongen
Jarno Melenhorst
Stéphanie O. Breukink
Kaatje Lenaerts
Rutger M. Schols
Nicole D. Bouvy
Laurents P. S. Stassen
Publication date
01-11-2019
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 11/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-06673-6

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