Abstract
Colorectal cancer is the second most common cancer in women and the third most common cancer in men in the world. Surgical resection is the gold standard treatment and minimally invasive surgery remains the standard of care. Anastomotic leakage is one of the most feared postoperative complications in colorectal surgery. Although several factors have been identified as possible causes of anastomotic leakage (i.e., surgical techniques, patient risk factors, suture material or devices), the complete pathogenesis is still unclear. The reported leak rate ranges from 1 to 30% and increases as the anastomosis is more distal. To date the most widely used methods to assess tissue perfusion includes the surgeon intraoperative visual judgement based on the colour; bleeding edges of resected margins; pulsation and temperature, thereby resulting in either excess or insufficient colonic resection. Earlier studies in colorectal surgery have suggested that assessment of tissue perfusion by the clinical judgment of the operating surgeon underestimated the risk of anastomotic leakage. Indocyanine green (ICG) is a intravenous dye which has shown promise in identifying the bowel vascularity real time. Earlier studies on colorectal cancer have shown that ICG based detection of bowel vascularity is technically possible and has reduced the anastomotic leak rates in 16.7% of patients. We conducted a prospective study on patients with ICG guided bowel perfusion during robotic colorectal cancer surgery. The method is technically easy, reproducible and safe. This technique has changed the intraoperative decision in 88% of patients. Larger studies are needed before this can become the standard of care.
Highlights
Colorectal cancer is the second most common cancer in women and the third most common cancer in men in the world [1]
Surgical resection is the gold standard of treatment for colorectal cancer and minimally invasive surgery remains the standard of care [4]
Several factors have been identified as possible causes of anastomotic leakage, the complete pathogenesis is still unclear
Summary
Colorectal cancer is the second most common cancer in women and the third most common cancer in men in the world [1]. Indocyanine green (ICG) is a new dye which has shown promise in identifying colonic vascularity [13] This is a sterile, anionic, water-soluble but relatively hydrophobic, Tri carbocyanine molecule and, once injected into the vascular system, binds to plasma proteins [14]. It becomes fluorescent when excited by near-infrared light and has shown to identify the real-time image of vascularity of colon with a line of transection, thereby decreasing the risk of anastomotic leak and unnecessary excess colonic mobilization. Earlier studies in colorectal cancer have shown that ICG based detection of bowel vascularity has changed the plan of extensive bowel resection in 30% to 50% of patients and significantly reduced the anastomotic leak rates [16, 17]. The perfusion images were recorded and assessed in real time
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