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 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.
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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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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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DOI: https://doi.org/10.1007/s00384-023-04363-3