Does routine use of indocyanine green fluorescence angiography prevent anastomotic leaks? A retrospective cohort analysis

Dinallo, Anthony; Kolarsick, Paul; Boyan, William; Protyniak, Bogdan; James, Abi; Dressner, Roy M.; Arvanitis, Michael L.

doi:10.1016/j.amjsurg.2018.10.027

Cited by 29 publications

(13 citation statements)

References 15 publications

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“…The most significant input in this meta-analysis was provided by Watanabe et al [ 37 ] This propensity score-matched cohort study created the largest statistical weight of 16% with OR value of 0.43 (95% CI, 0.20–0.93), favoring the intraoperative assessment of anastomosis perfusion in lowering the AL rates after lower gastrointestinal tract resections. Kin et al [ 29 ] and Dinallo et al [ 35 ] studies, though showing the equivocal effects of testing and non-testing in reducing the AL rates (1.20 [95% CI, 0.52–2.75] and 1.03 [95% CI, 0.23–4.63]), were included in the meta-analysis due to not statistical additional significance. Kin et al [ 29 ] trial was the first to explore the role of ICG-FA in improving outcomes in colorectal surgery.…”

Section: Resultsmentioning

confidence: 99%

“…Kin et al [ 29 ] trial was the first to explore the role of ICG-FA in improving outcomes in colorectal surgery. Similarly, Dinallo et al [ 35 ] trial presented the new North American experience.…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, we calculated sensitivities for experimental groups (Supplemental Digital Content [Table, SDC 5]). Starker et al, [ 33 ] Kudszus et al, [ 27 ] and Dinallo et al [ 35 ] studies showed the highest, while Watanabe et al, [ 37 ] Kin et al, [ 29 ] and Kim et al [ 30 ] —the lowest (or not expressible) sensitivity values. Moreover, 1.00 sensitivity can be considered as false positive.…”

Section: Resultsmentioning

confidence: 99%

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Intraoperative testing of colorectal anastomosis and the incidence of anastomotic leak

et al. 2020

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Background: AL remains one of the most threatening complications in colorectal surgery. Significant efforts are put to understand the pathophysiological mechanisms involved in the development of leakage and to create the strategies to prevent it. We aimed to determine whether intraoperative testing of mechanical integrity and perfusion of colorectal anastomosis could reduce the incidence of AL. Methods: A systematic review and meta-analysis of papers published before November 2019 on PubMed, Scopus, Web of Science, and Cochrane Library databases and comparing intraoperative testing of the colorectal anastomosis with standard care were conducted. Odds ratios (ORs) and 95% confidence interval (CIs) were used to assess the association between intraoperative testing and AL. Results: A total of 23 studies totaling 7115 patients were included. Pooled analysis revealed intraoperative tests, for integrity (OR 0.52, 95% CI 0.34–0.82, P < .001) and perfusion (OR 0.40, 95% CI 0.22–0.752, P < .001) of the lower gastrointestinal tract anastomoses are associated with significantly lower AL rate. Conclusions: Intraoperative testing for either integrity or perfusion of anastomoses both reduce the AL rate. Studies looking at the combination of these two testing methods of anastomosis, especially intraoperative endoscopy, and indocyanine green fluorescence angiography may be very promising to further reduction of the AL.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Intraoperative testing of colorectal anastomosis and the incidence of anastomotic leak

et al. 2020

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“…Nine studies evaluated the use of ICG FA in a combination of patients undergoing both colon and rectal surgery. 11e13,23,25,29,32,33,39 Although the majority of studies adopted a laparoscopic approach, some studies included a combination of laparoscopic and open approaches, 11,13,23,25,32 whereas others included robotic-assisted surgery, 13,24,26,31 and 1 evaluated the use of ICG FA in transanal, total mesorectal excision. 35 There was also variability regarding the definition of anastomotic leakage.…”

Section: Study Characteristicsmentioning

confidence: 99%

Indocyanine green fluorescence angiography decreases the risk of colorectal anastomotic leakage: Systematic review and meta-analysis

Chan

Lee

Ang

2020

Surgery

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Background: Anastomotic leakage after a colorectal resection results in devastating consequences for patients. Indocyanine green fluorescence angiography is a modality to visualize vascular perfusion at the anastomotic site and can help surgeons decide the viability of the anastomosis. We performed this systematic review and meta-analysis to evaluate the efficacy of indocyanine green fluorescence angiography in decreasing anastomotic leakage. Methods: PubMed, Web of Science, Embase, and the Cochrane Library were searched to identify studies comparing the use of indocyanine green fluorescence angiography versus standard care on rates of anastomotic leakage. Data were pooled with the Mantel-Haenszel method and analyzed based on a random-effects model to estimate the pooled odds ratio and 95% confidence interval. The heterogeneity of studies was evaluated using I 2 statistic. Results: Twenty studies were included in this meta-analysis of 5,498 patients. The pooled estimate of the odds ratio was 0.46 (95% confidence interval 0.34e0.62; P < .00001) favoring indocyanine green fluorescence angiography. The overall anastomotic leak rate was 3.7% (n ¼ 82) in the intervention group and 8.6% (n ¼ 282) in the control group. Indocyanine green fluorescence angiography led to a change in the anastomotic site in 216 (9.7%) patients. Subgroup analyses of anastomotic leakage requiring intervention, patients requiring a low colorectal anastomosis, and prospective studies had a pooled estimate of odds ratio 0.55 (95% confidence interval 0.35e0.89), odds ratio 0.38 (95% confidence interval 0.27e0.54; P < .0001), and odds ratio 0.49 (95% confidence interval 0.30e0.81; P ¼ .005) respectively. Conclusion: The use of indocyanine green fluorescence angiography is associated with a decrease in anastomotic leakage. This association is present in patients with severe anastomotic leakage requiring intervention as well as low colorectal anastomoses.

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“…However, absolute quantification of blood flow is not possible and preliminary data are controversial ( Fig. 9; [103][104][105][106][107][108][109][110]).…”

Section: Visualization Of the Gastric Tube's Perfusionmentioning

confidence: 99%

Minimally invasive esophagectomy

Wykypiel

Schmid

Gehwolf

2019

memo

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Background Minimally invasive techniques have replaced the conventional open approach in many operations. For esophagectomy, it took quite a long time to become routine even in centers. The aim of this review was to demonstrate history and current status of minimally invasive esophagectomy and also robotic-assisted esophagectomy with its associated techniques. Methods Selected literature on minimally invasive surgery for esophageal cancer was identified using a PubMed search for the period 1990-2018 with the search terms esophagectomy, minimal invasive, robotic, indocyanine fluorescein, enhanced recovery after surgery (ERAS), fast-track, nerve monitoring and its permutations. Results Within the last two decades minimally invasive esophagectomy has found its way into clinical practice. It reduces perioperative morbidity with equivalent oncological outcome. It allows for better pulmonary results, less blood loss, less pain, and better quality of life. If robotic assisted esophagectomy helps to further improve the results is currently under investigation. Fast-track protocols have proven their value. Intraoperative nerve monitoring and indocyanine green fluorescein imaging of the perfusion of the gastric tube can lower perioperative complications. Conclusions Minimally invasive surgery for esophageal malignancies offers advantages when performed in an environment with sufficient expertise and caseload. Whether robotic-assisted minimally invasive esophagectomy further improves the results

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Does routine use of indocyanine green fluorescence angiography prevent anastomotic leaks? A retrospective cohort analysis

Cited by 29 publications

References 15 publications

Intraoperative testing of colorectal anastomosis and the incidence of anastomotic leak

Intraoperative testing of colorectal anastomosis and the incidence of anastomotic leak

Indocyanine green fluorescence angiography decreases the risk of colorectal anastomotic leakage: Systematic review and meta-analysis

Minimally invasive esophagectomy

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