Fluorescence‐based bowel anastomosis perfusion evaluation: results from the IHU‐IRCAD‐EAES EURO‐FIGS registry

Abstract

Background Anastomotic leakage (AL) is one of the dreaded complications following surgery in the digestive tract. Nearinfrared fluorescence (NIRF) imaging is a means to intraoperatively visualize anastomotic perfusion, facilitating fluorescence image-guided surgery (FIGS) with the purpose to reduce the incidence of AL. The aim of this study was to analyze the current practices and results of NIRF imaging of the anastomosis in digestive tract surgery through the EURO-FIGS registry. Methods Analysis of data prospectively collected by the registry members provided patient and procedural data along with the ICG dose, timing, and consequences of NIRF imaging. Among the included upper-GI, colorectal, and bariatric surgeries, subgroup analysis was performed to identify risk factors associated with complications. Results A total of 1240 patients were included in the study. The included patients, 74.8% of whom were operated on for cancer, originated from 8 European countries and 30 hospitals. A total of 54 surgeons performed the procedures. In 83.8% of cases, a pre-anastomotic ICG dose was administered, and in 60.1% of cases, a post-anastomotic ICG dose was administered. A significant difference (p < 0.001) was found in the ICG dose given in the four pathology groups registered (range: 0.013-0.89 mg/kg) and a significant (p < 0.001) negative correlation was found between the ICG dose and BMI. In 27.3% of the procedures, the choice of the anastomotic level was guided by means of NIRF imaging which means that in these cases NIRF imaging changed the level of anastomosis which was first decided based on visual findings in conventional white light imaging. In 98.7% of the procedures, the use of ICG partly or strongly provided a sense of confidence about the anastomosis. A total of 133 complications occurred, without any statistical significance in the incidence of complications in the anastomoses, whether they were ICG-guided or not. ConclusionThe EURO-FIGS registry provides an insight into the current clinical practice across Europe with respect to NIRF imaging of anastomotic perfusion during digestive tract surgery.

Indocyanine Green Fluorescence Angiography During Laparoscopic Bariatric Surgery: A Pilot Study

“…No adverse effects of ICG administration were observed in the reported series as in the present analysis, which therefore is confirmed to be a safe dye ( 22 , 24 , 27 ).…”

“…Some authors have recently used the intraluminal or intravenous administration of ICG to evaluate real-time tissue perfusion and to assess the integrity of the staple line during bariatric surgery, without, however, achieving definitive results yet ( 22 – 24 , 27 , 61 ).…”

“…In the literature, the use of ICG-FA during bariatric surgery is reported only in three articles ( 22 – 24 ), and by the results of Spota et al which report data obtained from 129 bariatric procedures with ICG-FA retrieved from the European-Fluorescence Imaging-Guided Surgery (EURO-FIGS) registry ( 27 ). They reported that the choice of the anastomotic level was ICG-FA unrelated in almost all cases and that the ICG-FA was primarily used to assess blood perfusion of the anastomoses, with a partial or high surgeons’ sense of confidence ( 27 ).…”

“…It is safe since adverse events are reported in less than 1 in 40.000 patients and mostly including hypersensitivity reactions ( 25 , 26 ). It is used in surgery for various purposes: evaluation of the anastomotic blood supply, visualization of the biliary tract during cholecystectomy, identification of the sentinel lymph node in breast cancer, melanoma and gastric carcinoma ( 27 – 32 ), but its use in bariatric surgery is still debated ( 22 – 24 ).…”

Indocyanine Green Near-Infrared Fluoroangiography Is a Useful Tool in Reducing the Risk of Anastomotic Leakage Following Left Colectomy

“…The still commonly used technique for evaluating local bowel perfusion at present is the subjective clinical estimation by the operating surgeon based on subjective criteria such as the color of serosa and mucosa, bleeding of the bowel ends, and pulsation of nearby small vessels. According to a recent analysis of the EURO-FIGS registry, in 27% of colorectal procedures, ICG-NIFA was used to assess colonic perfusion ( 30 ). In the present retrospective unicentric study in the setting of a teaching clinic, the overall AL rate after left colectomy (sigmoid resections and TMEs) of 1.4% was significantly lower in the ICG-NIFA group compared to 14.5% in the no-ICG-NIFA group ( p = 0.006).…”