Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawara-cho, Sakyo-ku, 606-8507, Kyoto, Japan.
Int J Clin Oncol. 2019 Apr;24(4):394-402. doi: 10.1007/s10147-018-1365-5. Epub 2018 Nov 8.
It remains unclear whether indocyanine green (ICG) angiography could reduce the rate of postoperative anastomotic leakage (AL) following rectal surgery. The aim was to determine whether intraoperative ICG angiography could decrease symptomatic AL following laparoscopic low anterior resection (LAR).
This is a retrospective study of 149 patients with rectal cancer who underwent laparoscopic LAR at a single institution. Propensity score matching (PSM) was employed to compare groups with and without ICG angiography.
Before PSM, the symptomatic AL rate was 10.4% (5/48) in patients with ICG angiography, compared with 6.9% (7/101) in cases without ICG angiography (P = 0.52). In patients with ICG angiography, poor perfusion of the proximal colon judged by ICG angiography led to additional colon resection in 27.1% (13/48). Symptomatic AL occurred in 30.8% (4/13) of the patients who had revision of the transection site, whereas it occurred in only 2.9% (1/35) of the patients who did not need revision of the transection site (P = 0.015). After PSM, the symptomatic AL rate was 8.8% (3/34) in patients with ICG angiography, compared with 14.7% (5/34) in cases without ICG angiography (P = 0.71). In univariate analysis, high BMI, preoperative chemotherapy, and lateral lymph node dissection were significantly associated with symptomatic AL. Multivariate analysis indicated that only lateral lymph node dissection remained significantly associated with AL (odds ratio, 10.05; 95% confidence interval, 1.75-58.61; P = 0.011).
Intraoperative ICG angiography is useful for prediction of AL following laparoscopic LAR.
目前仍不清楚吲哚菁绿（ICG）血管造影是否能降低直肠手术后吻合口漏（AL）的发生率。本研究旨在确定术中吲哚菁绿血管造影是否能降低腹腔镜低位前切除术（LAR）后症状性 AL 的发生率。
这是一项单中心回顾性研究，纳入 149 例直肠癌患者，均接受腹腔镜 LAR。采用倾向评分匹配（PSM）比较有无 ICG 血管造影两组。
在 PSM 之前，ICG 血管造影组的症状性 AL 发生率为 10.4%（5/48），而无 ICG 血管造影组为 6.9%（7/101）（P=0.52）。在有 ICG 血管造影组中，ICG 血管造影判断近端结肠灌注不良导致 27.1%（13/48）的患者需要额外结肠切除。需要重建吻合口的患者中，30.8%（4/13）发生症状性 AL，而不需要重建吻合口的患者中仅 2.9%（1/35）发生（P=0.015）。PSM 后，ICG 血管造影组的症状性 AL 发生率为 8.8%（3/34），而无 ICG 血管造影组为 14.7%（5/34）（P=0.71）。单因素分析显示，高 BMI、术前化疗和侧方淋巴结清扫与症状性 AL 显著相关。多因素分析表明，仅侧方淋巴结清扫与 AL 显著相关（比值比，10.05；95%置信区间，1.75-58.61；P=0.011）。
术中吲哚菁绿血管造影有助于预测腹腔镜 LAR 后 AL 的发生。
