SP3.1.7 Does using intra-operative indocyanine green impact the clinical suspicion of anastomotic leak?

Abstract

Abstract Aims To see if the beneficial impact of indocyanine green (ICG) angiography on anastomotic leak (AL) rate was reflected in the “suspicion” of leak in patients undergoing rectal or sigmoid cancer resection. Methods Patients who have intra-operative ICG fluorescence have reduced clinical AL rates, with a shorter length of stay (LOS). Recent publications have suggested stricter criteria to categorize AL. A prospectively-maintained database was reviewed to see if there was a difference in the suspicion of AL between patients who did and did not receive intra-operative ICG. A total of 159 rectal and sigmoid cancers were diagnosed between 1 April 2020 and 31 March 2021 in our health board, with 75 patients proceeding to surgery. Only patients receiving primary anastomosis were included in this study (n=33). Post-operative CT scans performed, diagnosis of AL, Clavien-Dindo complication rates, use of antibiotics beyond 48 hours, and LOS, were studied. Results 39.4% (n=13/33) received intra-operative ICG whilst 60.6% (n=20/33) did not. The median LOS was 3 days in the ICG group and 6.5 days in the non-ICG group. There were less CT scans, antibiotic use, complications, and post-operative interventions in the ICG cohort. Conclusion This is a small-sized snapshot audit, however it demonstrates that the reduced AL rate in patients having intra-operative ICG is reflected in their post-op journey of care, with a clear difference in interventions, and no greater number of “sub-clinical” leaks in the ICG cohort. The study will be expanded to see if this data is consistent in a larger study.