Intraoperative angiography with indocyanine green to assess anastomosis perfusion in patients undergoing laparoscopic colorectal resection

results of a multicenter randomized controlled trial

Paola De Nardi, Ugo Elmore, Giulia Maggi, Riccardo Maggiore, Luigi Boni, Elisa Cassinotti, Uberto Fumagalli, Marco Gardani, Stefano De Pascale, Paolo Parise, Andrea Vignali, Riccardo Rosati

Research output: Contribution to journalArticle

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Abstract

Background: Insufficient vascular supply is one of the main causes of anastomotic leak in colorectal surgery. Intraoperative indocyanine-green (ICG) angiography has been shown to provide information on tissue perfusion, identifying a well-perfused location for colonic and rectal transections, and thus possibly reducing the leak rate. Aim of this study was to evaluate the usefulness of intraoperative assessment of anastomotic perfusion using ICG angiography in patients undergoing left-sided colon or rectal resection with colorectal anastomosis. Methods: This randomized trial involved 252 patients undergoing laparoscopic left-sided colon and rectal resection randomized 1:1 to intraoperative ICG or to subjective visual evaluation of the bowel perfusion without ICG. The primary aim was to assess whether ICG angiography could lead to a reduction in anastomotic leak rate. Secondary outcomes were possible changes in the surgical strategy and postoperative morbidity. Results: After randomization, 12 patients were excluded. Accordingly, 240 patients were included in the analysis; 118 were in the study group, and 122 in the control group. ICG angiography showed insufficient perfusion of the colic stump, which led to extended bowel resection in 13 cases (11%). An anastomotic leak developed in 11 patients (9%) in the control group and in 6 patients (5%) in the study group (p = n.s.). Conclusions: Intraoperative ICG fluorescent angiography can effectively assess vascularization of the colic stump and anastomosis in patients undergoing colorectal resection. This method led to further proximal bowel resection in 13 cases, however, there was no statistically significant reduction of anastomotic leak rate in the ICG arm. Clinical trial: ClinicalTrials.gov NCT02662946.

Original languageEnglish
JournalSurgical Endoscopy
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Indocyanine Green
Angiography
Randomized Controlled Trials
Perfusion
Anastomotic Leak
Colic
Colon
Control Groups
Colorectal Surgery
Random Allocation
Blood Vessels
Clinical Trials
Morbidity

Keywords

  • Anastomosis perfusion
  • Anastomotic leak
  • Colorectal resection
  • Intraoperative indocyanine-green angiography

ASJC Scopus subject areas

  • Surgery

Cite this

Intraoperative angiography with indocyanine green to assess anastomosis perfusion in patients undergoing laparoscopic colorectal resection : results of a multicenter randomized controlled trial. / De Nardi, Paola; Elmore, Ugo; Maggi, Giulia; Maggiore, Riccardo; Boni, Luigi; Cassinotti, Elisa; Fumagalli, Uberto; Gardani, Marco; De Pascale, Stefano; Parise, Paolo; Vignali, Andrea; Rosati, Riccardo.

In: Surgical Endoscopy, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Intraoperative angiography with indocyanine green to assess anastomosis perfusion in patients undergoing laparoscopic colorectal resection: results of a multicenter randomized controlled trial",
abstract = "Background: Insufficient vascular supply is one of the main causes of anastomotic leak in colorectal surgery. Intraoperative indocyanine-green (ICG) angiography has been shown to provide information on tissue perfusion, identifying a well-perfused location for colonic and rectal transections, and thus possibly reducing the leak rate. Aim of this study was to evaluate the usefulness of intraoperative assessment of anastomotic perfusion using ICG angiography in patients undergoing left-sided colon or rectal resection with colorectal anastomosis. Methods: This randomized trial involved 252 patients undergoing laparoscopic left-sided colon and rectal resection randomized 1:1 to intraoperative ICG or to subjective visual evaluation of the bowel perfusion without ICG. The primary aim was to assess whether ICG angiography could lead to a reduction in anastomotic leak rate. Secondary outcomes were possible changes in the surgical strategy and postoperative morbidity. Results: After randomization, 12 patients were excluded. Accordingly, 240 patients were included in the analysis; 118 were in the study group, and 122 in the control group. ICG angiography showed insufficient perfusion of the colic stump, which led to extended bowel resection in 13 cases (11{\%}). An anastomotic leak developed in 11 patients (9{\%}) in the control group and in 6 patients (5{\%}) in the study group (p = n.s.). Conclusions: Intraoperative ICG fluorescent angiography can effectively assess vascularization of the colic stump and anastomosis in patients undergoing colorectal resection. This method led to further proximal bowel resection in 13 cases, however, there was no statistically significant reduction of anastomotic leak rate in the ICG arm. Clinical trial: ClinicalTrials.gov NCT02662946.",
keywords = "Anastomosis perfusion, Anastomotic leak, Colorectal resection, Intraoperative indocyanine-green angiography",
author = "{De Nardi}, Paola and Ugo Elmore and Giulia Maggi and Riccardo Maggiore and Luigi Boni and Elisa Cassinotti and Uberto Fumagalli and Marco Gardani and {De Pascale}, Stefano and Paolo Parise and Andrea Vignali and Riccardo Rosati",
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T1 - Intraoperative angiography with indocyanine green to assess anastomosis perfusion in patients undergoing laparoscopic colorectal resection

T2 - results of a multicenter randomized controlled trial

AU - De Nardi, Paola

AU - Elmore, Ugo

AU - Maggi, Giulia

AU - Maggiore, Riccardo

AU - Boni, Luigi

AU - Cassinotti, Elisa

AU - Fumagalli, Uberto

AU - Gardani, Marco

AU - De Pascale, Stefano

AU - Parise, Paolo

AU - Vignali, Andrea

AU - Rosati, Riccardo

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Insufficient vascular supply is one of the main causes of anastomotic leak in colorectal surgery. Intraoperative indocyanine-green (ICG) angiography has been shown to provide information on tissue perfusion, identifying a well-perfused location for colonic and rectal transections, and thus possibly reducing the leak rate. Aim of this study was to evaluate the usefulness of intraoperative assessment of anastomotic perfusion using ICG angiography in patients undergoing left-sided colon or rectal resection with colorectal anastomosis. Methods: This randomized trial involved 252 patients undergoing laparoscopic left-sided colon and rectal resection randomized 1:1 to intraoperative ICG or to subjective visual evaluation of the bowel perfusion without ICG. The primary aim was to assess whether ICG angiography could lead to a reduction in anastomotic leak rate. Secondary outcomes were possible changes in the surgical strategy and postoperative morbidity. Results: After randomization, 12 patients were excluded. Accordingly, 240 patients were included in the analysis; 118 were in the study group, and 122 in the control group. ICG angiography showed insufficient perfusion of the colic stump, which led to extended bowel resection in 13 cases (11%). An anastomotic leak developed in 11 patients (9%) in the control group and in 6 patients (5%) in the study group (p = n.s.). Conclusions: Intraoperative ICG fluorescent angiography can effectively assess vascularization of the colic stump and anastomosis in patients undergoing colorectal resection. This method led to further proximal bowel resection in 13 cases, however, there was no statistically significant reduction of anastomotic leak rate in the ICG arm. Clinical trial: ClinicalTrials.gov NCT02662946.

AB - Background: Insufficient vascular supply is one of the main causes of anastomotic leak in colorectal surgery. Intraoperative indocyanine-green (ICG) angiography has been shown to provide information on tissue perfusion, identifying a well-perfused location for colonic and rectal transections, and thus possibly reducing the leak rate. Aim of this study was to evaluate the usefulness of intraoperative assessment of anastomotic perfusion using ICG angiography in patients undergoing left-sided colon or rectal resection with colorectal anastomosis. Methods: This randomized trial involved 252 patients undergoing laparoscopic left-sided colon and rectal resection randomized 1:1 to intraoperative ICG or to subjective visual evaluation of the bowel perfusion without ICG. The primary aim was to assess whether ICG angiography could lead to a reduction in anastomotic leak rate. Secondary outcomes were possible changes in the surgical strategy and postoperative morbidity. Results: After randomization, 12 patients were excluded. Accordingly, 240 patients were included in the analysis; 118 were in the study group, and 122 in the control group. ICG angiography showed insufficient perfusion of the colic stump, which led to extended bowel resection in 13 cases (11%). An anastomotic leak developed in 11 patients (9%) in the control group and in 6 patients (5%) in the study group (p = n.s.). Conclusions: Intraoperative ICG fluorescent angiography can effectively assess vascularization of the colic stump and anastomosis in patients undergoing colorectal resection. This method led to further proximal bowel resection in 13 cases, however, there was no statistically significant reduction of anastomotic leak rate in the ICG arm. Clinical trial: ClinicalTrials.gov NCT02662946.

KW - Anastomosis perfusion

KW - Anastomotic leak

KW - Colorectal resection

KW - Intraoperative indocyanine-green angiography

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