The impact of indocyanine-green fluorescence angiogram on colorectal resection.
Aged
Anastomosis, Surgical
/ adverse effects
Anastomotic Leak
/ etiology
Colectomy
/ adverse effects
Colon, Sigmoid
/ blood supply
Coloring Agents
Female
Fluorescein Angiography
/ methods
Humans
Indocyanine Green
Male
Middle Aged
Proctectomy
/ adverse effects
Prospective Studies
Rectal Neoplasms
/ blood supply
Rectum
/ blood supply
Sigmoid Neoplasms
/ blood supply
Anastomotic leak
Bowel perfusion
Colorectal resection
ICG
Indocyanine-green
Journal
The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
ISSN: 1479-666X
Titre abrégé: Surgeon
Pays: Scotland
ID NLM: 101168329
Informations de publication
Date de publication:
Oct 2019
Oct 2019
Historique:
received:
04
06
2018
revised:
08
08
2018
accepted:
16
08
2018
pubmed:
10
9
2018
medline:
18
2
2020
entrez:
10
9
2018
Statut:
ppublish
Résumé
Perfusion plays an important role in anastomotic healing. Indocyanine-green fluorescence angiogram allows objective bowel perfusion assessment. This study aimed to investigate the impact of perfusion assessment on intraoperative decision during left-sided colorectal resections. This was a prospective, single-centre, observational study recruiting patients with left-sided colorectal resections. Perfusion of bowel segment was assessed with ICG fluorescence angiogram prior to resection and anastomosis intra-operatively. The planned transection site and the actual transection site after perfusion assessment were compared. The decision for diversion stoma was also evaluated. 110 patients with cancer of the sigmoid colon (29.1%) and rectum (70.9%) were recruited. Total mesorectal excision was performed in 51.8% of patients. The transection site was revised in 34.5% of cases: 30.9% more proximally and 3.6% more distally. The median distance between the intended and actual transection sites was 2 cm (range 1-17 cm). A proximal revision in the transection site was more likely seen in rectal cancers (p = 0.036, OR 3.58, 95% CI 1.09-11.78) and relatively under-perfused left colon (p = 0.036, OR 1.01, 95% CI 1.01-1.02). Three (2.7%) patients were spared from a diversion stoma. The overall anastomotic leakage rate was 5.5%. ICG fluorescence angiogram altered operative decisions in a significant proportion of cases. The impact on transection site was more pronounced in patients with rectal cancers and those with relatively under-perfused colon.
Sections du résumé
BACKGROUND
BACKGROUND
Perfusion plays an important role in anastomotic healing. Indocyanine-green fluorescence angiogram allows objective bowel perfusion assessment. This study aimed to investigate the impact of perfusion assessment on intraoperative decision during left-sided colorectal resections.
METHOD
METHODS
This was a prospective, single-centre, observational study recruiting patients with left-sided colorectal resections. Perfusion of bowel segment was assessed with ICG fluorescence angiogram prior to resection and anastomosis intra-operatively. The planned transection site and the actual transection site after perfusion assessment were compared. The decision for diversion stoma was also evaluated.
RESULTS
RESULTS
110 patients with cancer of the sigmoid colon (29.1%) and rectum (70.9%) were recruited. Total mesorectal excision was performed in 51.8% of patients. The transection site was revised in 34.5% of cases: 30.9% more proximally and 3.6% more distally. The median distance between the intended and actual transection sites was 2 cm (range 1-17 cm). A proximal revision in the transection site was more likely seen in rectal cancers (p = 0.036, OR 3.58, 95% CI 1.09-11.78) and relatively under-perfused left colon (p = 0.036, OR 1.01, 95% CI 1.01-1.02). Three (2.7%) patients were spared from a diversion stoma. The overall anastomotic leakage rate was 5.5%.
CONCLUSION
CONCLUSIONS
ICG fluorescence angiogram altered operative decisions in a significant proportion of cases. The impact on transection site was more pronounced in patients with rectal cancers and those with relatively under-perfused colon.
Identifiants
pubmed: 30195865
pii: S1479-666X(18)30098-2
doi: 10.1016/j.surge.2018.08.006
pii:
doi:
Substances chimiques
Coloring Agents
0
Indocyanine Green
IX6J1063HV
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
270-276Informations de copyright
Copyright © 2018 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.