Near-infrared fluorescence angiography for colorectal surgery is associated with a reduction of anastomotic leak rate.

Abstract

Decreased blood perfusion at the anastomotic site increases the risk of anastomotic leakage (AL) following colorectal surgery. Indocyanine green near-infrared fluoroangiography (NIRF/ICG) is a technique that allows for the assessment of intestinal perfusion before and after the formation of an anastomosis. We aimed to compare the rate of AL after colorectal surgery conducted with NIRF/ICG assessing vascular anastomotic perfusion and without this support. The data of patients who underwent colorectal surgery from November 2014 to February 2019 were reviewed retrospectively. Left-sided hemicolectomy, sigmoid resection, and anterior rectal resection were included. Emergency resections were excluded. Procedures conducted with NIRF/ICG and without NIRF/ICG (no-NIRF/ICG) support were compared using Fisher's and Mann-Whitney U test. Overall, 196 procedures were included, 98 were carried out with no-NIRF/ICG and 98 with NIRF/ICG. Patients' clinical and intraoperative characteristics were similar in the two groups. In the NIRF/ICG, fluorescence was detected in 100% of the cases; following NIRF/ICG the planned site of transection was changed in eight cases, whereas in one case the anastomosis was re-performed. Overall, six patients (3%) developed an AL, 0% in the NIRF/ICG and 6% (n = 6) in the no-NIRF/ICG group (p = 0.029). Median hospital length of stay was shorter in the NIRF/ICG group [6days (IQR 6-7) vs. 7days (IQR 6-9), p < 0.001]. The results of this study suggest that the use of the NIRF/ICG was safe for colorectal surgery and decreases the risk of anastomotic leak. A randomized trial is required to confirm these preliminary data.