Evaluating the Effect of Intraoperative Near-Infrared Observation on Anastomotic Leakage After Stapled Side-to-Side Anastomosis in Colon Cancer Surgery Using Propensity Score Matching

Abstract

BACKGROUND: Recent studies have clarified that near-infrared observation using indocyanine green has the advantage of evaluating perfusion of the anastomotic site, especially in rectal cancer surgery, resulting in a reduction in anastomotic leak. OBJECTIVE: The aim of this study was to evaluate the efficacy of near-infrared observation for reducing the anastomotic leak after stapled side-to-side anastomosis in colon cancer surgery. DESIGN: This was a retrospective propensity score case-matched study. SETTINGS: The study was conducted at 3 institutions in the Yokohama Clinical Oncology Group. PATIENTS: From January 2011 to December 2019, patients who underwent colon cancer surgery with stapled side-to-side anastomosis were included. MAIN OUTCOME MEASURES: The main outcome was the percentage of anastomotic leak within 30 days after surgery. RESULTS: A total of 1034 patients were collected. There were 532 patients who underwent near-infrared observation and 502 who did not. A total of 370 patients were matched to the near-infrared and non-near-infrared groups. In the near-infrared group, 12 patients (3.2%) were judged to have poor perfusion (4 patients) and no perfusion (8 patients), so the planned transection point was changed. There were no cases of anastomotic leak among these 12 patients. The anastomotic leak rates were 3.5% (13/370) in the non-near-infrared group and 0.8% (3/370) in the near-infrared group. The anastomotic leak and reoperation rates were significantly lower in the near-infrared group than in the non-near-infrared group (OR, 0.224; 95% CI, 0.063–0.794, p = 0.001; OR, 0.348; 95% CI, 0.124–0.977, p = 0.036). LIMITATIONS: Although we reduced selection bias by performing propensity score matching, this was a retrospective study and was not randomized. CONCLUSION: This large-scale case-matched study showed that assessing perfusion by near-infrared observation significantly reduced the anastomotic leak and reoperation rates after stapled side-to-side anastomosis in colon cancer surgery and may be better suited to colo-colonic anastomosis. Video Abstract at http://links.lww.com/DCR/B513. Japanese Clinical Trials Registry: UMIN-CTR000039977 EVALUACIÓN DEL EFECTO DE LA OBSERVACIÓN INTRAOPERATORIA CON INFRARROJO CERCANO SOBRE LA FUGA ANASTOMÓTICA DESPUÉS DE UNA ANASTOMOSIS LATERO-LATERAL CON ENGRAPADORA EN LA CIRUGÍA DE CÁNCER DE COLON MEDIANTE EL EMPAREJAMIENTO POR PUNTAJES DE PROPENSIÓN ANTECEDENTES: Estudios recientes han aclarado que la observación con infrarrojo cercano con verde de indocianina tiene la ventaja de evaluar la perfusión del sitio anastomótico, especialmente en la cirugía de cáncer de recto, lo que resulta en una reducción de la fuga anastomótica. OBJETIVO: El objetivo de este estudio fue evaluar la eficacia de la observación con infrarrojo cercano para reducir la fuga anastomótica después de una anastomosis latero-lateral con engrapadora en la cirugía de cáncer de colon. DISEÑO: Este fue un estudio retrospectivo emparejado con puntaje de propensión. AJUSTE: El estudio se llevó a cabo en tres instituciones del Grupo de Oncología Clínica de Yokohama. PACIENTES: Desde enero de 2011 hasta diciembre de 2019, se incluyeron pacientes que se sometieron a cirugía de cáncer de colon con anastomosis latero-lateral con engrapadora. PRINCIPALES MEDIDAS DE RESULTADO: El resultado principal fue el porcentaje de fuga anastomótica dentro de los 30 días posteriores a la cirugía. RESULTADOS: Se recogió un total de 1034 pacientes. Hubo 532 pacientes que se sometieron a observación con infrarrojo cercano y 502 que no. Un total de 370 pacientes fueron emparejados con los grupos de infrarrojo cercano y no infrarrojo cercano. En el grupo de infrarrojo cercano, se consideró que 12 casos (3,2%) tenían mala perfusión (4 casos) y ninguna perfusión (8 casos), por lo que se cambió el punto de transección planificado. No hubo casos de fuga anastomótica entre estos 12 casos. Las tasas de fuga anastomótica fueron del 3,5% (13/370) en el grupo sin infrarrojo cercano y del 0,8% (3/370) en el grupo con infrarrojo cercano. Las tasas de fuga anastomótica y de reintervención fueron significativamente menores en el grupo con infrarrojo cercano que en el grupo sin infrarrojo cercano (razón de posibilidades 0,224, intervalo de confianza del 95% 0,063-0,794, p = 0,001; razón de posibilidades 0,348, intervalo de confianza del 95% 0,124 -0,977, p = 0,036, respectivamente). LIMITACIONES: Aunque se redujo el sesgo de selección al realizar el emparejamiento por puntaje de propensión, este fue un estudio retrospectivo y no fue aleatorio. CONCLUSIÓN: Este estudio de casos emparejados a gran escala demostró que la evaluación de la perfusión mediante la observación con infrarrojo cercano redujo significativamente la fuga anastomótica y las tasas de reintervención después de la anastomosis latero-lateral con engrapadora en la cirugía de cáncer de colon y puede ser más adecuada para la anastomosis colo-colónica. Consulte Video Resumen en http://links.lww.com/DCR/B513. Registro japonés de ensayos clínicos: UMIN-CTR000039977

Safety and Efficacy of Indocyanine Green in Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis of 11,047 Patients

“…A total of 1936 references were finally confirmed by the electronic search, and 73 potentially relevant studies were selected after screening the titles and abstracts. Among the 73 potentially relevant studies, a total of 32 met the inclusion criteria [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. Table 1 and Table S1 summarize the study characteristics.…”

“…The following supporting information can be downloaded at: . Table S1: Methodology characteristics of the included trials [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]; Table S2: Pooled analysis in subgroups of randomized and non-randomized trials; Table S3: PRISMA checklist. Figure S1: A summary table of the review authors’ judgements for each risk of bias item for each randomized study; Figure S2: A plot of the distribution of the review authors’ judgements for each risk of bias item across randomized studies; Figure S3: A summary table of the review authors’ judgements for each risk of bias item for each non-randomized study; Figure S4: A plot of the distribution of the review authors’ judgements for each risk of bias item across non-randomized studies.…”

Effect of Indocyanine Green Fluorescence Angiography on Anastomotic Leakage in Patients Undergoing Colorectal Surgery: A Meta-Analysis of Randomized Controlled Trials and Propensity-Score-Matched Studies

“…After excluding 592 duplicate records, 1,025 articles were eliminated by reading titles and abstracts. Full-text evaluation was conducted in the remaining 33 studies, and finally, 20 studies (20,21,26,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45) that met the inclusion criteria were included (Figure 1).…”

“…AL rate was reported in all 20 studies (20,21,26,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45).…”

“…Postoperative complications were described in 11 studies (20,21,31,32,34,36,37,(40)(41)(42)45). The total effect size indicated that intraoperative ICG fluorescence angiography did not reduce the incidence of total complications, with significant heterogeneity between studies (OR, 0.93; 95% CI, 0.64, 1.35; P = 0.70; I 2 = 64%) (Figure 5).…”