Intraoperative use of fluorescence with indocyanine green reduces anastomotic leak rates in rectal cancer surgery: an individual participant data analysis

Arezzo, Alberto; Bonino, Marco Augusto; Ris, Frédéric; Boni, Luigi; Cassinotti, Elisa; Foo, Chi Chung; Shum, Nga Fan; Brolese, Alberto; Ciarleglio, Francesco Antonio; Keller, Deborah S.; Rosati, Riccardo; Nardi, Paola De; Elmore, Ugo; Romario, Uberto Fumagalli; Jafari, Mehraneh D.; Pigazzi, Alessio; Rybakov, E. G.; Алексеев, М. В.; Watanabe, Jun; Vettoretto, Nereo; Cirocchi, Roberto; Passera, Roberto; Forcignanò, Edoardo; Morino, Mario

doi:10.1007/s00464-020-07735-w

Cited by 61 publications

(53 citation statements)

References 26 publications

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“…To this end, we are now using near-infrared laparoscopy, recently introduced to provide fast and reproducible real-time intraoperative assessment of intestinal microvascularization using indocyanine green angiography [23]. Recent data have suggested that the assessment of perianastomotic microvascularization may be associated with a reduction in the risk of fistula, pleading for the multifactorial etiology of this severe complication [24].…”

Section: Discussionmentioning

confidence: 99%

Postoperative Outcomes after Surgery for Deep Endometriosis of the Sacral Plexus and Sciatic Nerve: A 52-patient Consecutive Series

Roman

Dehan²,

Merlot

et al. 2021

Journal of Minimally Invasive Gynecology

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To assess 1-year postoperative outcomes of surgery for deep endometriosis involving the sacral roots and sciatic nerve. Design: Retrospective case series. Setting: Three referral centers. Patients: Fifty-two women. Interventions: Surgery for deep endometriosis involving the sacral roots and sciatic nerve. Measurements and Main Results: Deep endometriosis involved the sacral roots in 49 women (94.2%) and the sciatic nerve in 3 cases (5.8%). Sciatic pain (buttock or leg) was recorded in 43 women (82.7%), pudendal neuralgia in 11 women (21.2%), and leg motor weakness in 14 cases (27%). The surgical procedures carried out on the pelvic nerves included complete release and decompression (92.3%), excision of the epineurium by shaving (5.8%), and intraneural excision (1.9%). Additional major surgical procedures involved the digestive tract in 82.7% of the cases and the urinary tract in 46.2%. Rectovaginal fistula occurred in 13.5% of the cases. Self-catheterization was required in 14 cases (27%) at 3 weeks after surgery and in 3 women (5.8%) 12 months later. One-year follow-up showed significant improvement in quality of life measured using the Short-Form 36 questionnaire and standardized gastrointestinal scores. De novo hypoesthesia, hyperesthesia, or allodynia were recorded in 9 women (17.2%). The cumulative pregnancy rate was 77.2%% after natural conception in 47%. Conclusion: Laparoscopic management of deep endometriosis involving the sacral roots and sciatic nerve improves patients' symptoms and overall quality of life. Although pain reduction may be rapid after surgery, other sensory or motor complaints, including bladder dysfunction, may be recorded over months or years. Journal of Minimally Invasive Gynecology (2020) 00, 1−9.

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Section: Discussionmentioning

confidence: 99%

Postoperative Outcomes after Surgery for Deep Endometriosis of the Sacral Plexus and Sciatic Nerve: A 52-patient Consecutive Series

Roman

Dehan²,

Merlot

et al. 2021

Journal of Minimally Invasive Gynecology

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“…Still, some had various biases or showed insufficient statistical power. However, the overall perception is that ICG does improve the rates of anastomotic complications, especially in left colorectal surgery, with solid randomized controlled trials being expected to confirm this [ 58 , 59 , 60 , 61 ].…”

Section: Discussionmentioning

confidence: 99%

“…ICG NIR fluorescence proved to be a reliable tool in evaluation the lymphatic flow and in identifying the SL. However, with a universally accepted lower clinical significance for the concept of SL in colorectal surgery in comparison to breast and skin malignancies, the use of this method in establishing suitable candidates for limited colonic resections remains controversial [ 60 , 62 , 63 , 64 , 68 ].…”

Section: Discussionmentioning

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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“…It has reportedly been used for evaluation of residual gastric blood flow in pancreatic resection after gastrectomy [14][15][16]. It has also been reported that ICG fluorescence was used to assess blood flow at the colonic anastomosis to reduce the suture failure rate [17,18]. In esophagectomy, ICG fluorescence has been used to assess gastric conduit blood flow [19][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Successful management of gastric remnant necrosis after proximal gastrectomy using a double elementary diet tube: a case report

et al. 2020

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Background The stomach has many incoming vessels and is resistant to ischemia due to the rich microvascular network within its submucosal layer. Although reports of gastric remnant necrosis after gastrectomy have been rare, mortality rates remain substantially high when present. A double elementary diet (W-ED) tube, which can be used for both enteral feeding and gastrointestinal tract decompression, has been developed for anastomotic leakage and postoperative nutritional management after upper gastrointestinal surgery. The current report presents a case of gastric remnant necrosis after proximal gastrectomy that was successfully managed through conservative treatment with a W-ED tube. Case presentation A 73-year-old male was referred to our hospital for an additional resection after endoscopic submucosal dissection (ESD) for gastric cancer. Endoscopic findings showed an ESD scar on the posterior wall of the upper portion of the stomach, while computed tomography (CT) showed no obvious regional lymph node enlargement and distant metastases. The patient subsequently underwent laparoscopic proximal gastrectomy and esophagogastrostomy but developed candidemia on postoperative day 7. On postoperative day 14, endoscopy revealed gastric ischemic changes around the anastomotic site, suggesting that the patient’s candidemia developed due to gastric necrosis. His vital signs remained normal, while the gastric remnant ischemia was localized. Given that surgery in the presence of candidemia was considered extremely risky, conservative treatment was elected. A W-ED tube was placed nasally, after which enteral feeding was initiated along with gastrointestinal tract decompression. Although the patient subsequently developed anastomotic leakage due to gastric remnant necrosis, local control was achieved and conservative treatment was continued. On postoperative day 52, healing of the gastric remnant necrosis and anastomotic leakage was confirmed, after which the patient started drinking water. Although balloon dilation was required due to anastomotic stenosis, the patient was able to resume oral intake and was discharged on postoperative day 88. Conclusions Herein, we present our experience with a case of gastric remnant necrosis after proximal gastrectomy, wherein conservative management was achieved using a W-ED tube. In cases involving high operative risk, the management should be mindful of gastric remnant necrosis as a post-gastrectomy complication.

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Intraoperative use of fluorescence with indocyanine green reduces anastomotic leak rates in rectal cancer surgery: an individual participant data analysis

Abstract: Intraoperative use of fluorescence with indocyanine green reduces anastomotic leak rates in rectal cancer surgery: an individual participant data analysis.

Cited by 61 publications

References 26 publications

Postoperative Outcomes after Surgery for Deep Endometriosis of the Sacral Plexus and Sciatic Nerve: A 52-patient Consecutive Series

Postoperative Outcomes after Surgery for Deep Endometriosis of the Sacral Plexus and Sciatic Nerve: A 52-patient Consecutive Series

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

Successful management of gastric remnant necrosis after proximal gastrectomy using a double elementary diet tube: a case report

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