Indocyanine green fluorescence angiography to evaluate anastomotic perfusion in colorectal surgery

• Published in: International journal of colorectal disease Vol. 35; no. 6; pp. 1133 - 1139
• Main Authors: Tsang, Yi-po, Leung, Lik-Hang Alex, Lau, Chi-wai, Tang, Chung-ngai
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2020; Springer; Springer Nature B.V
• Subjects: Aged; Anastomosis; Anastomosis, Surgical; Anastomotic leak; Anastomotic Leak - etiology; Angiography; Colon - blood supply; Colon - surgery; Colorectal surgery; Coloring Agents; Comparative analysis; Female; Fluorescein Angiography; Fluorescence; Gastroenterology; Hepatology; Humans; Indocyanine Green; Internal Medicine; Male; Medical imaging; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Metronidazole; Middle Aged; Neomycin; Original Article; Patients; Perfusion; Proctology; Prospective Studies; Surgery; Toxicity; Colorectal resection; Indocyanine green; Fluorescence imaging; ICG; Anastomotic perfusion
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-020-03592-0

Background
The aim of this study was to evaluate the efficacy of indocyanine green (ICG) fluorescence angiography with respect to the anastomotic leakage rate for patients undergoing colorectal operations.
Methods
This prospective cohort involved patients who underwent colorectal surgery between August 2018 and September 2019. ICG was injected after colonic transection. Vascular perfusion was observed by ICG fluorescence system before completing anastomosis. Data was compared with those by subjective visual evaluation. The primary outcome was anastomotic leakage rate within 30 days from surgery.
Results
A total of 131 patients were enrolled, of which ICG was injected in 63 of them. Demographic data were similar between the two groups. There were two (3.23%) and three (4.35%) anastomotic leaks in the ICG and non-ICG group respectively (
p
 = 1.000). Change of resection plane occurred in one patient in the ICG group. There was no ICG related toxicity or adverse events.
Conclusion
ICG fluorescent imaging is a feasible and safe tool to assess colonic vascularisation for patients undergoing colorectal surgery. However, it did not significantly lower the anastomotic leakage rate. ICG should not be routinely used in colorectal surgery before an available large scale randomised controlled trial to prove any clinical benefits.