Otero-Piñeiro A M, de Lacy F B, Van Laarhoven J J, Martín-Perez B, Valverde S, Bravo R, Lacy A M
Department of Gastrointestinal Surgery, Hospital Clinic, University of Barcelona, AIS Channel, Barcelona, Spain.
Department of Surgery, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, The Netherlands.
Surg Endosc. 2021 Feb;35(2):754-762. doi: 10.1007/s00464-020-07442-6. Epub 2020 Feb 18.
Anastomotic leak (AL) is the most feared complication in colorectal surgery. Indocyanine green (ICG) fluorescence angiography allows for real-time intraoperative evaluation of bowel perfusion. This study aimed to assess the impact of ICG on perioperative outcomes in patients treated with transanal total mesorectal excision (TaTME) for rectal cancer.
Comparative study based on a retrospective analysis of prospectively collected data, to validate the use of ICG assessment (ICGA) during TaTME (November/2011-June/2018). The primary outcome was the clinical AL rate. The secondary outcomes included modification of proximal colonic transection, anastomotic redo, additional surgical maneuvers and surgical morbidity.
Two hundred and eighty-four patients were included, 204 (71.8%) in non-ICG group and 80 (28.2%) in ICG group. No significant differences were found in patient and tumor features. Mean anastomotic height was 4.85 cm vs. 5.04 cm (p = 0.500), diverting stoma was constructed in 205 patients (72.1% vs. 72.5%; p = 0.941). Fluorescence angiography modified the surgical plan in 23 patients (28.7%). AL was diagnosed in 23 patients (11.3%) in the non-ICG group and in two patients (2.5%) in the ICG group (p = 0.020). Postoperative intraabdominal collection was diagnosed in 19 patients (7.4% vs. 5.1%; p = 0.490), and reintervention was needed in 24 patients (10.8% vs. 7.6%; p = 0.420). Median length of hospital stay was 6.0 (IQR 5.0-9) vs. 4.0 (IQR 3.0-8.5) (p = 0.005). ICGA was found as independent protective factor for AL in the multivariate analysis of the whole cohort (n = 284) (OR 0.142; 95% CI 0.032-0.633; p = 0.010).
ICG fluorescence angiography modified the proximal colonic transection in more than one-quarter of patients, leading to a significant decrease of AL rate.
吻合口漏（AL）是结直肠手术中最令人担忧的并发症。吲哚菁绿（ICG）荧光血管造影可在术中实时评估肠管灌注情况。本研究旨在评估ICG对接受经肛门全直肠系膜切除术（TaTME）治疗的直肠癌患者围手术期结局的影响。
基于对前瞻性收集数据的回顾性分析进行比较研究，以验证TaTME手术期间（2011年11月至2018年6月）ICG评估（ICGA）的应用。主要结局是临床AL发生率。次要结局包括近端结肠切断的调整、吻合口再次手术、额外的手术操作和手术并发症。
纳入284例患者，非ICG组204例（71.8%），ICG组80例（28.2%）。患者和肿瘤特征方面未发现显著差异。平均吻合口高度分别为4.85 cm和5.04 cm（p = 0.500），205例患者（72.1%对72.5%；p = 0.941）行转流造口术。荧光血管造影改变了23例患者（28.7%）的手术方案。非ICG组23例患者（11.3%）诊断为AL，ICG组2例患者（2.5%）诊断为AL（p = 0.020）。19例患者诊断为术后腹腔积液（7.4%对5.1%；p = 0.490），24例患者需要再次干预（10.8%对7.6%；p = 0.420）。中位住院时间分别为6.0（IQR 5.0 - 9）天和4.0（IQR 3.0 - 8.5）天（p = 0.005）。在整个队列（n = 284）的多因素分析中，ICGA被发现是AL的独立保护因素（OR 0.142；95%CI 0.032 - 0.633；p = 0.010）。
ICG荧光血管造影使超过四分之一的患者近端结肠切断情况得到改变，导致AL发生率显著降低。
