Abstract
We aimed to evaluate the clinical feasibility of a new visual grading system. We included 50 patients who underwent resection of primary colorectal cancer. Before anastomosis, the marginal vessel was cut and the perfusion status was assessed by a visual grading system. The visual grading system is comprised of five grades according to the bleeding from the marginal vessel and is categorized into 4 groups: good (grade A and B), moderate (grade C), poor (grade D) and none (grade E). Colorectal anastomosis was performed only in the good and moderate groups. We compared postoperative outcomes between the good and moderate groups and analysed the factors affecting the perfusion grade. Among the patients, 48% were grade A, 12% were grade B, and 40% were grade C. There was no anastomotic leakage. Only one patient with grade C showed ischemic colitis and needed reoperation. Age was the only factor correlated with perfusion grade in multivariate analysis (OR 1.080, 95% CI 1.006–1.159, p = 0.034). The perfusion grades were significantly different between > 65 and < 65 year-old patients (> 65, A 29.2% B 12.5% C 58.3% vs. < 65, A 65.4% B 11.5% C 23.1%, p = 0.006). Our intraoperative perfusion assessment that uses a cutting method and a visual grading system is simple and useful for performing a safe anastomosis after colorectal resection. If the perfusion grade is better than grade C, an anastomosis can be performed safely. Age was found to be an important factor affecting the perfusion grade.
Highlights
An adequate blood supply is important for safe colorectal anastomosis in colorectal cancer surgery
After the inferior mesenteric artery is ligated at its origin during left-sided colorectal cancer surgery, the blood supply of the bowel, which located in the proximal end, is provided by the marginal artery fed from the middle colic v essels[8]
We hypothesized that visual grading of the degree of blood supply in the marginal vessels on the proximal end of the anticipated anastomosis was possible, and a grading system could be utilized as an assessment tool for safe anastomosis after resection in left-sided colorectal cancer patients
Summary
An adequate blood supply is important for safe colorectal anastomosis in colorectal cancer surgery. The most commonly used method for evaluating colonic perfusion is to observe the colour of the colon wall or the pulse of small vessels on the colonic mesentery[8]. The clinical utility of near-infrared fluorescence angiography with indocyanine green (ICG) has been r eported[12,13] Notwithstanding, these tests other than the observation of the colour or pulse during surgery are not widely used due to the high price of the equipment, technical difficulties, and their lack of reproducibility[14]. We hypothesized that visual grading of the degree of blood supply in the marginal vessels on the proximal end of the anticipated anastomosis was possible, and a grading system could be utilized as an assessment tool for safe anastomosis after resection in left-sided colorectal cancer patients. This study aimed to evaluate the clinical feasibility of a new visual grading system for safe colorectal anastomosis and to identify clinical factors associated with the perfusion grade in left-sided colorectal cancer patients
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