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Feasibility of quantitative analysis of colonic perfusion using indocyanine green to prevent anastomotic leak in colorectal surgery

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A Correction to this article was published on 09 February 2022

This article has been updated

Abstract

Background

The aim of this study was to quantify Fluorescence angiography with indocyanine green (ICG) in colorectal cancer anastomosis, determine influential factors in its temporary intensity and pattern, assessing the ability to predict the AL, and setting the cut-off levels to establish high- or low-risk groups.

Methods

Retrospective analysis of prospectively managed database, including 70 patients who underwent elective surgery for colorectal cancer in which performing a primary anastomosis was in primary plan. In all of them, ICG fluorescence angiography was performed as usual clinical practice with VisionSense™ VS Iridium (Medtronic, Mansfield, MA, USA), in Elevision™ IR Platform (Medtronic, Mansfield, MA, USA). Parameters measured at real time or calculated were T0, Tmax, ∆T, Fmax, %pos, Fpos, and Slope.

Results

70 patients were included, 69 anastomosis were performed and one end colostomy. Arterial hypertension demonstrated higher Fmax, as well as the location of the anastomosis (the nearest to rectum, the most intensity detected). A statistical relationship was found between AL and the lower Fpos and Slope. The decision of changing the subjectively decided point of division did not demonstrate statistical difference on the further development of AL. All parameters were analyzed to detect the cut-off related with AL. Only in case of Fpos lower than 158.3 U and Slope lower than 13.1 U/s p-value were significant. The most valuable diagnostic parameter after risk stratification was the Negative Predictive Value.

Conclusion

Quantitative analysis of ICG fluorescence in colorectal surgery is safe and feasible to stratify risk of AL. Hypertension and location of anastomosis influence the intensity of fluorescence at the point of section. A change of division place should be considered to avoid AL related to vascular reasons when intensities of fluorescence at the point of section is lower than 169 U or slopes lower than 14.4 U/s.

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Change history

  • 08 February 2022

    This article was updated to correct the sentence in the Discussion section which now reads “As observed in our experience, in 16(23.2%) patients…” (rather than “As observed in our experience, in 8(11.5%) patients…”).

  • 09 February 2022

    A Correction to this paper has been published: https://doi.org/10.1007/s00464-022-09085-1

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This work has not received funding for its realization or for its publication.

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Authors and Affiliations

  1. Colorectal Surgery Unit, General and Digestive Surgery, University Hospital Virgen Macarena, Dr Fedriani s/n, 41009, Seville, Spain

    Juan-Carlos Gomez-Rosado, Javier Valdes-Hernandez, Juan Cintas-Catena, Auxiliadora Cano-Matias, Asuncion Perez-Sanchez, Francisco-Javier del Rio-Lafuente, Cristina Torres-Arcos, Luis-Cristobal Capitan-Morales & Fernando Oliva-Mompean

  2. General and Digestive Surgery, University Hospital Virgen Macarena, Seville, Spain

    Yaiza Lara-Fernandez

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  1. Juan-Carlos Gomez-Rosado
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Correspondence to Juan-Carlos Gomez-Rosado.

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Juan-Carlos Gomez-Rosado, Javier Valdes-Hernandez, Juan Cintas-Catena, Auxiliadora Cano-Matias, Asuncion Perez-Sanchez, Francisco-Javier del Rio-Lafuente, Cristina Torres-Arcos, Yaiza Lara-Fernandez, Luis-Cristobal Capitan-Morales, and Fernando Oliva-Mompean declare that they have no conflicts of interest in relation to the published content.

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Gomez-Rosado, JC., Valdes-Hernandez, J., Cintas-Catena, J. et al. Feasibility of quantitative analysis of colonic perfusion using indocyanine green to prevent anastomotic leak in colorectal surgery. Surg Endosc 36, 1688–1695 (2022). https://doi.org/10.1007/s00464-021-08918-9

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