Efficacy of intraoperative indocyanine green fluorescence imaging evaluation for preventing anastomotic leakage after laparoscopic rectal cancer surgery

doi:10.16139/j.1007-9610.2023.03.012

Abstract

Abstract:

Objective To investigate the effect of indocyanine green(ICG) fluorescence imaging to indicate blood supply of sigmoid-rectal anastomosis in laparoscopic anterior resection of rectal cancer. Methods Here a retrospective cohort study including 175 consecutive patients with rectal cancer scheduled for laparoscopic surgery in Department of Gastrointestinal Surgery of Renji Hospital between January 2019 and December 2022 was analysed. These patients were classified into two groups, according to using ICG or not within surgery: the ICG group (n=65) and the control group (n=110). Operation situations and complications were compared between the two groups. Results The operation time of ICG group was longer than that of control group [(151.6±4.8) min vs (139.5±3.7) min, P=0.04], and the preventive ileostomy rate was lower than that of control group (12.3% vs 34.6%, P=0.01), while the other operation data (intraoperative blood loss, number of lymph node dissection), were similar between the two groups (P>0.05). The rate of anastomotic leakage in ICG group were lower than that in control group (4.6% vs 14.6%, P=0.04), and there was no significant differences in wound infection, urinary retention and intestinal obstruction between the two groups (P>0.05). Conclusions The ICG displays that the blood supply in laparoscopic anterior resection of rectal cancer can reduce the incidence of anastomotic leakage, which improves the surgical safety and the quality of postoperative life.

Key words: Laparoscopy, Anterior resection of rectal cancer, Indocyanine green, Anastomotic leakage

CLC Number:

R735.37

LUO Yang, YU Minhao, YE Guangyao, LIN Haiping, GONG Tingyue, LI Hao, ZHONG Ming. Efficacy of intraoperative indocyanine green fluorescence imaging evaluation for preventing anastomotic leakage after laparoscopic rectal cancer surgery[J]. Journal of Surgery Concepts & Practice, 2023, 28(03): 249-253.

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Clinicopathological features	Control group （n=110）	ICG group （n=65）	Statistical value	P value
Gender
Male	62 (56.4)	40 (61.5)	χ²=0.45	0.50
Female	48 (43.6)	25 (38.5)	χ²=0.45	0.50
Age(years)	62.2±1.0	63.9±0.9	t=1.17	0.24
BMI (kg/m²)	21.8± 0.3	21.9±0.4	t=0.28	0.78
Tumor size (cm)	4.6±0.2	4.4±0.3	t=0.59	0.56
Preoperative CEA (μg/mL)	18.2± 8.1	22.5±10.9	t=0.32	0.75
TNM Stage
Stage Ⅰ	8 (7.3)	5 (7.7)	χ²=0.66	0.71
Stage Ⅱ	66 (60.0)	35 (53.8)
Stage Ⅲ	36 (32.7)	25 (38.5)

Postoperative recovery	Control group （n=110）	ICG group （n=65）	Statistical value	P value
First postoperative anal ventilation time （h）	75.4±1.7	72.0±2.4	t=1.18	0.24
Postoperative hospitalization time （d）	10.4±0.6	9.7±0.7	t=0.70	0.49
Anastomotic leakage
Yes	16 (14.5)	3 (4.6)	χ²=4.16	0.04
No	94 (85.5)	62 (95.4)
Urinary retention
Yes	10(9.1)	7 (10.8)	χ²=0.13	0.72
No	100 (90.9)	58 (89.2)
Wound infection
Yes	11 (10.0)	6 (9.2)	χ²=0.28	0.87
No	99 (90.0)	59 (90.8)
Intestinal obstruction
Yes	7 (6.4)	3 (4.7)	χ²=0.23	0.63
No	103 (93.6)	62(95.4)

Clinicopathological feature	Control group （n=110）	ICG group （n=65）	t value	P value
Bleeding volume （mL）	109.3±6.1	117.7±8.8	0.81	0.42
Operative time （min）	139.5± 3.7	151.6±4.8	2.01	0.04
Preventive stoma (case)	38 (34.6)	8 (12.3)	6.29	0.01
Number of lymph node	12.7±0.5	13.1±0.7	0.45	0.65