Is intraoperative fluorescence imaging with indocyanine green associated with a lower incidence of anastomotic leakage after colorectal surgery? A propensity score matching study

Abstract

Background: Anastomotic leakage (AL) is a major complication of colorectal resection. The objective of the present study was to determine the influence of intraoperative fluorescence imaging with indocyanine green (ICG) on the incidence of AL after colorectal resection and anastomosis. Methods: From January 2003 to June 2019, we included consecutive patients having undergone colorectal resection with anastomosis in a retrospective, propensity score matching study based on the American Society of Anesthesiology (ASA) classification, the indication for surgery, the type of resection, and the surgical approach. The control group comprised patients operated on between January 2003 and December 2015 who had not undergone an intraoperative ICG test. The ICG group included all patients operated on between January 2016 and June 2019 and who had undergone an intraoperative ICG test. The endpoints were the incidence of AL, a change in the resection site, the medical complication rate, the surgical complication rate, and the mortality rate at postoperative day 30. Results: We treated 835 patients (158 in the ICG group and 677 in the control group) during the study period. After propensity score matching, the AL rate was 1.9% in the ICG group and 5.8% in the control group (odds ratio (OR) 0.42; 95% confidence interval (CI) 0.19–0.97; p = 0.041). After the ICG test, the resection site was modified for 6 of the 158 patients (4%) in the ICG group. The medical complication rate was 33.5% in the ICG group and 29% in the control group (OR 1.16; 95% CI 0.76–1.76; p = 0.5). The surgical complication rate was 32.3% in the ICG group and 32.6% in the control group (OR 0.84; 95% CI 0.55–1.28; p = 0.42). The mortality rate was 0.6% in the ICG group and 4.1% in the control group (OR: 0.14; 95% CI 0.050–0.39; p <0.001). Conclusion: Intraoperative fluorescence imaging with ICG is associated with a lower incidence of AL