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Is ICG essential in all colorectal surgery? A 3-year experience in a single center: a cohort study

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Introduction and objectives

Indocyanine green (ICG) was introduced as a promising diagnostic tool to provide real-time assessment of intestinal vascularization. Nevertheless, it remains unclear whether ICG could reduce the rate of postoperative AL. The objective of this study is to assess its usefulness and to determine in which patients is most useful and would benefit the most from the use of ICG for intraoperative assessment of colon perfusion.

Methods

A retrospective cohort study was conducted in a single center, including all patients who underwent colorectal surgery with intestinal anastomosis between January 2017 and December 2020. The results of patients in whom ICG was used prior to bowel transection were compared with the results of the patients in whom this technique was not used. Propensity score matching (PSM) was employed to compare groups with and without ICG.

Results

A total of 785 patients who underwent colorectal surgery were included. The operations performed were right colectomies (35.0%), left colectomies (48.3%), and rectal resections (16.7%). ICG was used in 280 patients. The mean time since the infusion of ICG until detection of fluorescence in the colon wall was 26.9 ± 1.2 s. The section line was modified in 4 cases (1.4%) after ICG due to a lack of perfusion in the chosen section line. Globally, a non-statistically significant increase in anastomotic leak rate was observed in the group without ICG (9.3% vs. 7.5%; p = 0.38). The result of the PSM was a coefficient of 0.026 (CI − 0.014 to 0.065, p = 0.207).

Conclusions

ICG is a safe and useful tool to assess the perfusion of the colon prior to performing the anastomosis in colorectal surgery. However, in our experience, it did not significantly lower the anastomotic leakage rate.

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Data sharing

Data from the study will be shared with researchers interested in them. Deidentified participant data and data dictionaries will be shared upon request from the corresponding author after publication. All relevant data are within the paper and its supporting information files.

References

  1. Frasson M, Flor-Lorente B, Ramos Rodríguez JL, Granero Castro P, Hervás D, Álvarez Rico MA, Brao MJG, Sánchez González JM, García Granero E (2015) Risk factors for anastomotic leak after colon resection for cancer. Ann Surg 262:321–330

    Article  PubMed  Google Scholar 

  2. Vignali A, Gianotti L, Braga M et al (2000) Altered microperfusion of the rectal stump is predictive for rectal anastomotic leak. Dis Colon Rectum 30:867–871

    Google Scholar 

  3. Horgan PG, Gorey TF (1992) Operative assessment of intestinal viability. Surg Oncol Clin N Am 72:143–155

    Article  CAS  Google Scholar 

  4. Urbanaviĉius L, Pattyn P, de Putte DV, Venskutonis D (2011) How to assess intestinal viability during surgery: a review of techniques. World J Gastrointest Surg 3:59–69

    Article  PubMed  PubMed Central  Google Scholar 

  5. Schaafsma B, Mieog J, Hutteman M, Van der Vorst J, Kuppen P, Löwik C, Frangioni J, Van de Velde C, Vahrmeijer A (2011) The clinical use of indocyanine green as a near-infrared fluorescent contrast agent for image-guided oncologic surgery. J Surg Oncol 104(3):323–332

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Alander J, Kaartinen I, Laakso A, Pätilä T, Spillmann T, Tuchin V, Venermo M, Välisuo P (2012) A review of indocyanine green fluorescent imaging in surgery. Int J Biomed Imaging 1:1–26

    Article  Google Scholar 

  7. Boni L, David G, Mangano A, Dionigi G, Rausei S, Spampatti S, Cassinotti E, Fingerhut A (2015) Clinical applications of indocyanine green (ICG) enhanced fluorescence in laparoscopic surgery. Surg Endosc 29:2046–2055

    Article  PubMed  Google Scholar 

  8. Arezzo A, Bonino M, Ris F et al (2020) Intraoperative use of fluorescence with indocyanine green reduces anastomotic leak rates in rectal cancer surgery: an individual participant data analysis. Surg Endosc 34:4281–4290

    Article  PubMed  Google Scholar 

  9. - Losurdo P, Mis T, Cosola D et al (2020) Anastomotic leak: is there still a place for indocyanine green fluorescence imaging in colon-rectal surgery? A retrospective, propensity score – matches cohort study. Surg Innov 1–8

  10. Wada T, Kawada K, Hoshino N et al (2019) The effects of intraoperative ICG fluorescence angiography in laparoscopic low anterior resection: a propensity score-matched study. Int J Clin Oncol 24:394–402

    Article  PubMed  Google Scholar 

  11. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    Article  PubMed  Google Scholar 

  12. Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G, for the STROCSS Group (2019) The STROCSS 2019 Guideline: strengthening the reporting of cohort studies in surgery. Int J Surg 72:156–165

    Article  PubMed  Google Scholar 

  13. Daams F, Wu Z, Lahaye M, Jeekel J, Lange J (2014) Prediction and diagnosis of colorectal anastomotic leakage: a systematic review of literature. World J Gastrointest Surg 6(2):14–26

    Article  PubMed  PubMed Central  Google Scholar 

  14. 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 30:2736–2742

    Article  PubMed  Google Scholar 

  15. Jafari M, Wexner S, Martz J (2015) Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg 220(1):82–92

    Article  PubMed  Google Scholar 

  16. James D, Ris F, Yeung T, Kraus R, Buchs N, Mortensen N, Hompes R (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 3:16–21

    Article  Google Scholar 

  17. De Nardi P, Elmore U, Maggi G et al (2020) Intraoperative angiography with indocyanine green to assess anastomosis perfusion in patients undergoing laparoscopic colorectal resection: results of a multicenter randomized controlled trial. Surg Endosc 34:53–60

    Article  PubMed  Google Scholar 

  18. Aawsaj Y, Mustafa A, Winstanley J, O’loughlin P (2021) The impact of indocyanine green fluorescence angiography on intraoperative decision making in right hemicolectomy: a case-control study. Surg Laparosc Endosc Percutan Tech 32(2):209–212

    Article  PubMed  Google Scholar 

  19. Morales-Conde S, Alarcón I, Yang T, Licardie E, Camacho V, Aguilar del Castillo F et al (2020) Fluorescence angiography with indocyanine green (ICG) to evaluate anastomosis in colorectal surgery: where does it have more value? Surg Endosc 34:3897–3907

    Article  PubMed  Google Scholar 

  20. Kin C, Vo H, Welton L, Welton M (2015) Equivocal effect of intraoperative fluorescence angiography on colorectal anastomotic leaks. Dis Colon Rectum 58(6):582–587

    Article  PubMed  Google Scholar 

  21. Jafari M, Pigazzi A, McLemore E et al (2021) Perfusion Assessment in left-sided/low anterior resection (PILLAR III). Dis Colon Rectum. https://doi.org/10.1097/DCR.0000000000002007

    Article  PubMed  Google Scholar 

  22. Alekseev M, Rybakov E, Shelygin Y, Chernyshov S, Zarodnyuk I (2020) A study investigating the perfusion of colorectal anastomoses using fluorescence angiography: results of the FLAG randomized trial. Colorectal Dis 22(9):1147–1153

    Article  CAS  PubMed  Google Scholar 

  23. Dinallo AM, Kolarsick P, Boyan WP, Protyniak B, James A, Dressner RM, Arvanitis ML (2019) Does routine use of indocyanine green fluorescence angiography prevent anastomotic leaks? A retrospective cohort analysis. Am J Surg 218(1):136–139

    Article  PubMed  Google Scholar 

  24. Ahn HM, Son GM, Lee IY, Park SH, Kim NS, Baek KR (2021) Optimization of indocyanine green angiography for colon perfusion during laparoscopic colorectal surgery. Colorectal Dis 23(7):1848–1859

    Article  PubMed  PubMed Central  Google Scholar 

  25. Park S, Park H, Baek K, Ahn H, Lee I, Son G (2020) Artificial intelligence based real-time microcirculation analysis system for laparoscopic colorectal surgery. World J Gastroenterol 26(44):6945–6962

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Meijer RPJ, Faber RA, Bijlstra OD et al (2022) AVOID; a phase III, randomized controlled trial using indocyanine green for the prevention of anastomotic leakage in colorectal surgery. BMJ Open 12:e051144. https://doi.org/10.1136/bmjopen-2021-051144

    Article  PubMed  PubMed Central  Google Scholar 

  27. Armstrong G, Croft J, Corrigan N, Brown JM, Goh V, Quirke P, Hulme C, Tolan D, Kirby A, Cahill R, O’Connell PR, Miskovic D, Coleman M, Jayne D (2018) IntAct: intra-operative fluorescence angiography to prevent anastomotic leak in rectal cancer surgery: a randomized controlled trial. Colorectal Dis 20(8):O226–O234. https://doi.org/10.1111/codi.14257

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Complejo Hospitalario Universitario de Vigo, C/ Clara Campoamor 341, Vigo, Pontevedra, Zip Code: 36213, Spain

    Erene Flores-Rodríguez, Lucia Garrido-López, Raquel Sánchez-Santos, Oscar Cano-Valderrama, Laura Rodríguez-Fernández, Manuel Nogueira-Sixto, Marta Paniagua-García Señorans, Vincenzo Vigorita & Enrique Moncada-Iribarren

  2. Instituto de Investigación Galicia Sur, Pontevedra, Spain

    Raquel Sánchez-Santos, Oscar Cano-Valderrama & Vincenzo Vigorita

Authors
  1. Erene Flores-Rodríguez
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  2. Lucia Garrido-López
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  3. Raquel Sánchez-Santos
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  4. Oscar Cano-Valderrama
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Contributions

Erene Flores-Rodríguez: conceptualization, data curation, formal analysis, investigation, methodology, project administration, validation, and writing — original draft. Lucia Garrido-López: conceptualization, formal analysis, project administration, supervision, validation, and writing — review and editing. Raquel Sánchez-Santos: conceptualization, validation, and writing — review and editing, final approval of the version to be published. Oscar Cano-Valderrama: conceptualization, formal analysis, investigation, supervision, project administration and writing — review and editing. Laura Rodríguez-Fernández: data curation, formal analysis, and investigation. Manuel Nogueira-Sixto: data curation, formal analysis, and investigation. Marta Paniagua-García Señorans: data curation, formal analysis, and investigation. Vincenzo Vigorita: conceptualization, investigation, project administration, supervision, validation, and writing — review and editing. Enrique Moncada-Iribarren: project administration, supervision, and final approval of the version to be published.

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Correspondence to Erene Flores-Rodríguez.

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Flores-Rodríguez, E., Garrido-López, L., Sánchez-Santos, R. et al. Is ICG essential in all colorectal surgery? A 3-year experience in a single center: a cohort study. Int J Colorectal Dis 38, 67 (2023). https://doi.org/10.1007/s00384-023-04363-3

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