ICG angiography in prevention of colorectal anastomotic leakage

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Bedzhanyan A.L.

Petrovsky National Research Center of Surgery

ORCID: 0000-0002-4377-0035

Petrenko K.N.

Petrovsky National Research Center of Surgery

ORCID: 0000-0003-1705-928X

Sumbaev A.A.

Petrovsky National Research Center of Surgery

ORCID: 0000-0001-5518-9179

Frolova Yu.V.

Petrovsky Russian Scientific Center of Surgery

ORCID: 0000-0002-8546-5952

Nikoda V.V.

Petrovsky National Research Center of Surgery

ORCID: 0000-0001-9605-254X

Butenko A.V.

Petrovsky National Research Center of Surgery

ORCID: 0000-0003-4390-9276

ICG angiography in prevention of colorectal anastomotic leakage

Authors:

Bedzhanyan A.L., Petrenko K.N., Sumbaev A.A., Frolova Yu.V., Nikoda V.V., Butenko A.V.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2023;(9‑2): 25‑32

DOI: 10.17116/hirurgia202309225

Views: 1616

Downloaded: 109

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To cite this article:

Bedzhanyan AL, Petrenko KN, Sumbaev AA, Frolova YuV, Nikoda VV, Butenko AV. ICG angiography in prevention of colorectal anastomotic leakage. Pirogov Russian Journal of Surgery. 2023;(9‑2):25‑32. (In Russ.)
https://doi.org/10.17116/hirurgia202309225

Подписка 2025-2 (Pirogov Russian Journal of Surgery)

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OBJECTIVE

To evaluate the effectiveness of indocyanine green fluorescence angiography in assessment of colorectal anastomosis perfusion.

MATERIAL AND METHODS

A prospective single-center non-randomized comparative study included 85 patients with rectum and sigmoid colon cancer between September 2019 and March 2023. In the main group (n=41), we intraoperatively injected indocyanine green (ICG) IV to assess perfusion in the near infrared spectrum. In the control group (n=44), the same interventions were performed without ICG.

RESULTS

In the main group, anterior resection of the rectum was performed in 23 (56.1%) patients with neoplasms of distal sigmoid colon and rectosigmoid tumors. Low anterior resection was performed in 18 (43.9%) cases. In the control group, the same procedures were carried out in 24 (54.5%) and 20 (45.5%) patients, respectively. After mobilization of the colon and ICG injection, we corrected resection line in 4 cases. As soon as anastomosis was formed and blood supply was controlled by ICG fluorescence angiography, we performed a water-bubble test to detect anastomotic leakage. Positive tests were detected in 4 (9.8%) and 5 (11.4%) patients of both groups, respectively. Postoperative complications occurred in 10 (24.4%) and 11 (27.3%) patients, respectively (p=0.94). Anastomosis failure was found in 1 and 7 patients, respectively. Anastomotic leakage grade «B» was significantly more common in the control group (2.4 and 13.6%, respectively, p=0.06). Anastomotic leaks were absent in all 4 patients who underwent resection level adjustment after intraoperative ICG angiography.

CONCLUSION

Fluorescent luminescence will qualitatively improve intraoperative diagnosis of hypoperfusion of resection edges. Undoubtedly, this will reduce the incidence of colorectal anastomotic leaks caused by ischemia of large bowel wall.

Keywords:

colorectal anastomosis

leakage

indocyanine green

ICG angiography

Authors:

Bedzhanyan A.L.

Petrovsky National Research Center of Surgery

ORCID: 0000-0002-4377-0035

Petrenko K.N.

Petrovsky National Research Center of Surgery

ORCID: 0000-0003-1705-928X

Sumbaev A.A.

Petrovsky National Research Center of Surgery

ORCID: 0000-0001-5518-9179

Frolova Yu.V.

Petrovsky Russian Scientific Center of Surgery

ORCID: 0000-0002-8546-5952

Nikoda V.V.

Petrovsky National Research Center of Surgery

ORCID: 0000-0001-9605-254X

Butenko A.V.

Petrovsky National Research Center of Surgery

ORCID: 0000-0003-4390-9276

Received:

09.06.2023

Accepted:

29.06.2023

List of references:

Kang CY, Halabi WJ, Chaudhry OO, Nguyen V, Pigazzi A, Carmichael JC, Mills S, Stamos MJ. Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surgery. 2013;148(1):65-71. https://doi.org/10.1001/2013.jamasurg.2
Snijders HS, Wouters MW, van Leersum NJ, Kolfschoten NE, Henneman D, de Vries AC, Tollenaar RA, Bonsing BA. Meta-analysis of the risk for anastomotic leakage, the postoperative mortality caused by leakage in relation to the overall postoperative mortality. European Journal of Surgical Oncology. 2012;38(11):1013-1019. https://doi.org/10.1016/j.ejso.2012.07.111
La Regina D, Di Giuseppe M, Lucchelli M, Saporito A, Boni L, Efthymiou C, Cafarotti S, Marengo M, Mongelli F. Financial Impact of Anastomotic Leakage in Colorectal Surgery. Journal of Gastrointestinal Surgery. 2019;23(3):580-586. https://doi.org/10.1007/s11605-018-3954-z
Frasson M, Flor-Lorente B, Rodríguez JL, Granero-Castro P, Hervás D, Alvarez Rico MA, Brao MJ, Sánchez González JM, Garcia-Granero E; ANACO Study Group. Risk factors for anastomotic leak after colon resection for cancer: Multivariate analysis and nomogram from a multicentric, prospective, national study with 3193 patients. Annals of Surgery. 2015;262(2):321-330. https://doi.org/10.1097/SLA.0000000000000973
Ha GW, Kim JH, Lee MR. Oncologic Impact of Anastomotic Leakage Following Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis. Annals of Surgical Oncology. 2017;24(11):3289-3299. https://doi.org/10.1245/s10434-017-5881-8
Alekseev MV, Shelygin YuA, Rybakov EG. Prevention of colorectal anastomotic leakage by using of intraoperative fluorescent angiography: prospective trial data. Zhurnal im. N.I. Pirogova. 2018;8:47-51. (In Russ.). https://doi.org/10.17116/hirurgia201808247
McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. British Journal of Surgery. 2015;102(5):462-479. https://doi.org/10.1002/bjs.9697
Ortiz H, Biondo S, Codina A, Ciga MÁ, Enríquez-Navascués J, Espín E, García-Granero E, Roig JV. [Hospital variation in anastomotic leakage after rectal cancer surgery in the Spanish Association of Surgeons project: The contribution of hospital volume]. Cirugia Espanola. 2016;94(4):213-220. https://doi.org/10.1016/j.ciresp.2015.11.008
Lebedko MS, Gordeev SS, Alieva EV, Sivolob MD, Mamedli ZZ, Gaydarov SG, Kosyrev VYu. Risk factors for colorectal anastomotic leakage and preventive measures: a retrospective cohort study. Tazovaya hirurgiya i onkologiya. 2022;12(2):17-27. (In Russ.). https://doi.org/10.17650/2686-9594-2022-12-2-17-27
Chadi SA, Fingerhut A, Berho M, DeMeester SR, Fleshman JW, Hyman NH, Margolin DA, Martz JE, McLemore EC, Molena D, Newman MI, Rafferty JF, Safar B, Senagore AJ, Zmora O, Wexner SD. Emerging Trends in the Etiology, Prevention, and Treatment of Gastrointestinal Anastomotic Leakage. Journal of Gastrointestinal Surgery. 2016;20(12):2035-2051. https://doi.org/10.1007/s11605-016-3255-3
Sparreboom CL, Wu ZQ, Ji JF, Lange JF. Integrated approach to colorectal anastomotic leakage: Communication, infection and healing disturbances. World Journal of Gastroenterology. 2016;22(32):7226-7235. https://doi.org/10.3748/wjg.v22.i32.7226
Karliczek A, Harlaar NJ, Zeebregts CJ, Wiggers T, Baas PC, van Dam GM. Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery. International Journal of Colorectal Disease. 2009;24(5):569-576. https://doi.org/10.1007/s00384-009-0658-6
Reinhart MB, Huntington CR, Blair LJ, Heniford BT, Augenstein VA. Indocyanine Green :Historical Context, Current Applications, and Future Considerations. Surgical Innovation. 2016;23(2):166-175. https://doi.org/10.1177/1553350615604053
Luo S, Zhang E, Su Y, Cheng T, Shi C. A review of NIR dyes in cancer targeting and imaging. Biomaterials. 2011;32(29):7127-7138. https://doi.org/10.1016/j.biomaterials.2011.06.024
Vignali A, Gianotti L, Braga M, Radaelli G, Malvezzi L, Di Carlo V. Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak. Diseases of the Colon and Rectum. 2000;43(1):76-82. https://doi.org/10.1007/BF02237248
Kin C, Vo H, Welton L, Welton M. Equivocal effect of intraoperative fluorescence angiography on colorectal anastomotic leaks. Diseases of the Colon and Rectum. 2015;58(6):582-587. https://doi.org/10.1097/DCR.0000000000000320
Sheridan W.G., Lowndes R.H., Young H.L. Tissue oxygen tension as a predictor of colonic anastomotic healing. Diseases of the Colon and Rectum. 1987;30(11):867-871. https://doi.org/10.1007/BF02555426
Daams F, Wu Z, Lahaye MJ, Jeekel J, Lange JF. Prediction and diagnosis of colorectal anastomotic leakage: A systematic review of literature. World Journal of Gastrointestinal Surgery. 2014;6(2):14-26. https://doi.org/10.4240/wjgs.v6.i2.14
Boyle NH, Manifold D, Jordan MH, Mason RC. Intraoperative assessment of colonic perfusion using scanning laser doppler flowmetry during colonic resection. Journal of the American College of Surgeons. 2000;191(5):504-510. https://doi.org/10.1016/s1072-7515(00)00709-2
Karliczek A, Benaron DA, Baas PC, Zeebregts CJ, Wiggers T, van Dam GM. Intraoperative assessment of microperfusion with visible light spectroscopy for prediction of anastomotic leakage in colorectal anastomoses. Colorectal Disease. 2010;12(10):1018-1025. https://doi.org/10.1111/j.1463-1318.2009.01944.x
Kudszus S, Roesel C, Schachtrupp A, Höer JJ. Intraoperative laser fluorescence angiography in colorectal surgery: A noninvasive analysis to reduce the rate of anastomotic leakage. Langenbecks Archives of Surgery. 2010;395(8):1025-1030. https://doi.org/10.1007/s00423-010-0699-x
Pigazzi A, Luca F, Patriti A, Valvo M, Ceccarelli G, Casciola L, Biffi R, Garcia-Aguilar J, Baek JH. Multicentric study on robotic tumor-specific mesorectal excision for the treatment of rectal cancer. Annals of Surgical Oncology. 2010;17(6):1614-1620. https://doi.org/10.1245/s10434-010-0909-3
Jafari MD, Lee KH, Halabi WJ, Mills SD, Carmichael JC, Stamos MJ, Pigazzi A. The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery. Surgical Endoscopy. 2013;27(8):3003-3008. https://doi.org/10.1007/s00464-013-2832-8
Alekseev M, Rybakov E, Shelygin Y, Chernyshov S, Zarodnyuk I. A study investigating the perfusion of colorectal anastomoses using fluorescence angiography: results of the FLAG randomized trial. Colorectal Disease. 2020;22(9):1147-1153. https://doi.org/10.1111/codi.15037
Jafari MD, Wexner SD, Martz JE, McLemore EC, Margolin DA, Sherwinter DA, Lee SW, Senagore AJ, Phelan MJ, Stamos MJ. Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. Journal of the American College of Surgeons. 2015;220(1):82-92.e1. https://doi.org/10.1016/j.jamcollsurg.2014.09.015
Blanco-Colino R., Espin-Basany E. Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Techniques in Coloproctology. 2018;22(1):15-23. https://doi.org/10.1007/s10151-017-1731-8
Jafari MD, Pigazzi A, McLemore EC, Mutch MG, Haas E, Rasheid SH, Wait AD, Paquette IM, Bardakcioglu O, Safar B, Landmann RG, Varma MG, Maron DJ, Martz J, Bauer JJ, George VV, Fleshman JW Jr, Steele SR, Stamos MJ. Perfusion Assessment in Left-Sided/Low Anterior Resection (PILLAR III): A Randomized, Controlled, Parallel, Multicenter Study Assessing Perfusion Outcomes with PINPOINT Near-Infrared Fluorescence Imaging in Low Anterior Resection. Diseases of the Colon and Rectum. 2021;64(8):995-1001. https://doi.org/10.1097/DCR.0000000000002007

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