Indocyanine green fluorescence imaging to reduce the risk of anastomotic leakage in laparoscopic low anterior resection for rectal cancer: a propensity score-matched cohort study

Watanabe, Jun; Ishibe, Atsushi; Suwa, Yusuke; Suwa, Hirokazu; Ota, Mitsuyoshi; Kunisaki, Chikara; Endo, Itaru

doi:10.1007/s00464-019-06751-9

Cited by 152 publications

(155 citation statements)

References 38 publications

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“…LCA ligation does not significantly increase the risk of postoperative anastomotic leakage in PDM+ patients. In those with bear-claw IMAs, where marginal artery may originate from LCA, indocyanine green (ICG) imaging is perhaps indicated to better ascertain intestinal blood flow (4,13,14).…”

Section: Discussionmentioning

confidence: 99%

Persistent Descending Mesocolon as a Key Risk Factor in Laparoscopic Colorectal Cancer Surgery

Wang

Kondo

Hirano

et al. 2020

In Vivo

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Background: Persistent descending mesocolon (PDM) is a rare colonic anatomical variant. However, PDM's impact on the technical aspects and outcomes of laparoscopic colorectal cancer resection are unclear. Patients and Methods: This retrospective clinical cohort study was conducted at a high-volume cancer center in Japan to evaluate intra-and postoperative outcomes of laparoscopic colorectal cancer surgery in patients with (PDM+) or without (PDM-) PDM over the past 7 years. Results: Between January 2012 and September 2019, 2,775 patients underwent laparoscopic colorectal cancer resection at our center, including 60 (2.1%) cases of PDM. Preoperative detection was achieved in only 5 patients (8.3%), 39 patients were men, and 21 patients were women. The average age was 67 years. Twenty patients had a history of prior abdominal surgery (33.3%), with little or no subsequent adhesions. The average duration of sigmoidectomy in PDM+ patients (n=17; 217.7±14.2 min) was significantly longer than that in 176.2±2.4 min; p=0.003), as was average blood loss (32.3±10.6 ml vs. 16.7±2.8 ml; p=0.03). Likewise, average operative time for high anterior resection in PDM+ patients (n=11; 227.1±20.2 min) was significantly longer than that in 195.6±3.0 min; p=0.048). Rates of postoperative anastomotic leakage and postoperative recurrence did not differ in both groups. In PDM+ patients, retention of left colic artery had no impact on proximal specimen margins or occurrences of anastomotic leakage. Conclusion: PDM prolongs operative times and increases bleeding in laparoscopic colorectal cancer surgery and should be considered a risk factor when encountered.

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Section: Discussionmentioning

confidence: 99%

Persistent Descending Mesocolon as a Key Risk Factor in Laparoscopic Colorectal Cancer Surgery

Wang

Kondo

Hirano

et al. 2020

In Vivo

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“…There were also reports that performing radioisotope could assess colonic blood ow and reduce suture insu ciency. 7,8 ICG uorescence imaging showed good intestinal blood ow in all cases. It was con rmed that there were no complications due to impaired blood ow, such as an anastomotic leak, intestinal necrosis, or colostomy.…”

Section: Discussionmentioning

confidence: 81%

Laparoscopic Surgery and Robot-Assisted Surgery for Colorectal Cancer With Persistent Descending Mesocolon

Kojima

Sakamoto

Kawai

et al. 2020

Preprint

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Background: Persistent descending mesocolon (PDM) is a case of colonic replacement and adhesion as a result of abnormal fixation of the gastrointestinal tract. In laparoscopic surgery, it is performed when the patient is in an unconscious state. However, laparoscopic surgery, especially robot-assisted surgery, may necessarily need to devise surgical procedures such as anatomical recognition and adhesion detachment. We herein report three patients with PDM that were treated with arthroscopic surgery at our hospital. Case presentation: Patient 1: a 73-year-old man with sigmoid colon cancer. Laparoscopic sigmoidectomy was performed, and there were no problems encountered (such as difficulty in recognizing the anatomical location) other than adhesion detachment. Robot-assisted surgery was performed to the other two patients. Patient 2: a 62-year-old man with lower rectal cancer and underwent an intersphincteric resection. Patient 3: a 76-year-old man with lower rectal cancer and underwent Hartmann's operation. The surgery duration of these patients took longer, the same with robot-assisted surgeries without PDM. Conclusions: Robot-assisted surgeries have a large magnifying effect on delicately removing adhesions, which is a characteristic of PDM. Also, some parts are difficult to grasp as a whole, and it takes time to recognize adhesions anatomically and to grasp the whole image. Here, we report our experience with laparoscopic surgery and robot-assisted surgery for left-sided colorectal cancer with PDM.

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“…Our research identified 71 articles related to the use of ICG in vascular assessment of anastomoses, but only 23 papers remained eligible for review after a PRISMA evaluation [ 13 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. The ensuing comments and critical reflections are based on data from 3146 patients enrolled in 23 non-randomized studies on the use of ICG-enhanced NIR fluorescence for vascular evaluation of anastomoses in colorectal surgery involving open, laparoscopic, or robotic procedures ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…The sample size varied from 18 [ 21 ] to 504 patients [ 12 ]. Some authors included all colorectal surgeries [ 13 , 17 , 25 , 29 , 32 , 34 , 35 , 36 ] for both benign and malign pathologies, as well as for all locations, while others focused on the most vulnerable colorectal segments with regard to blood supply, namely, the left colon and low colorectal anastomosis [ 19 , 20 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 37 , 38 ]. In 13 of the studies [ 12 , 15 , 17 , 18 , 19 , 21 , 22 , 23 , 24 , 29 , 30 , 33 , 34 ], only the group of patients receiving ICG was described, while in 10 studies [ 16 , 20 , 25 , 26 , 27 , 28 , 31 , 32 , 35 ,...…”

Section: Resultsmentioning

confidence: 99%

Indocyanine Green-Enhanced Colorectal Surgery—between Being Superfluous and Being a Game-Changer

et al. 2020

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Nowadays, surgical innovations incorporate new technological conquests and must be validated by evidence-based medicine. The use of augmented reality-assisted indocyanine green (ICG) fluorescence has generated a myriad of intraoperative applications such as demonstration of key anatomical landmarks, sentinel lymph nodes, and real-time assessment of local blood flow. This paper presents a systematic review of the clinical evidence regarding the applications of ICG near-infrared (NIR) fluorescence in colorectal surgery. After we removed duplicate publications and screened for eligibility, a total of 36 articles were evaluated: 23 on perfusion assessment, 10 on lymph node mapping, and 3 on intraoperative identification of ureters. Lack of homogenous studies, low statistical power, and confounding evidence were found to be common amongst publications supporting the use of ICG in colorectal surgery, raising concerns over this seductive technique′s cost efficiency and redundancy. The compiled data showed that ICG NIR fluorescence may be a game-changer in particular situations, as proven for low colorectal anastomosis or lateral pelvic lymph node dissection, but it remains controversial for routine use and sentinel lymph node assessment. Further randomized studies are needed to confirm these conclusions. Future research directions include tumor-targeted fluorescence imaging and digital software for quantitative evaluation of fluorescence.

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Indocyanine green fluorescence imaging to reduce the risk of anastomotic leakage in laparoscopic low anterior resection for rectal cancer: a propensity score-matched cohort study

Cited by 152 publications

References 38 publications

Persistent Descending Mesocolon as a Key Risk Factor in Laparoscopic Colorectal Cancer Surgery

Persistent Descending Mesocolon as a Key Risk Factor in Laparoscopic Colorectal Cancer Surgery

Laparoscopic Surgery and Robot-Assisted Surgery for Colorectal Cancer With Persistent Descending Mesocolon

Indocyanine Green-Enhanced Colorectal Surgery—between Being Superfluous and Being a Game-Changer

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