Bonadio Laura, Iacuzzo Cristiana, Cosola Davide, Cipolat Mis Tommaso, Giudici Fabiola, Casagranda Biagio, Biloslavo Alan, de Manzini Nicolò
SC (UCO) Clinica Chirurgica, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149, Trieste, TS, Italy.
Biostatistics Unit, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
Updates Surg. 2020 Jun;72(2):477-482. doi: 10.1007/s13304-020-00725-6. Epub 2020 Feb 18.
Anastomotic leak (AL) is one of the worst complications of rectal anterior resection (RAR) and its incidence varies according to the anatomical site, increasing in lower anastomoses. Many etiological factors have been evaluated and most of these are related to bowel perfusion. Indocyanine green-enhanced fluorangiography (ICGf) has been proposed to help surgeons assess colonic perfusion with higher reliability than subjective clinical judgment. The aim of the study was to evaluate the efficacy of this tool in patients subjected to elective laparoscopic RAR for extraperitoneal rectal cancer. All the patients subjected to elective laparoscopic RAR for extraperitoneal rectal cancer between May 2015 and January 2017 were considered. In all of them, ICGf was performed to evaluate bowel perfusion. The control group included an equal number of patients subjected to the same procedure from January 2014 to April 2015, before the start of routine use of this tool at our institution. The endpoint of the study was to compare the incidence of AL between the two groups. A total of 33 patients were included in both groups. Relying on fluorescence intensity in the indocyanine green (ICG) group, we changed the level of resection in 6/33 patients (18.2%). An AL developed in 2/33 patients (6%) in the ICG group versus in 7/33 patients (21.2%) in the control group. The routine use of this technique may help surgeons in selecting the best level of proximal bowel resection during RAR.
吻合口漏（AL）是直肠前切除术（RAR）最严重的并发症之一，其发生率因解剖部位而异，低位吻合时发生率会增加。许多病因学因素已被评估，其中大多数与肠灌注有关。吲哚菁绿增强荧光血管造影术（ICGf）已被提出，以帮助外科医生比主观临床判断更可靠地评估结肠灌注。本研究的目的是评估该工具在接受选择性腹腔镜RAR治疗腹膜外直肠癌患者中的疗效。研究对象为2015年5月至2017年1月期间所有接受选择性腹腔镜RAR治疗腹膜外直肠癌的患者。对所有患者均进行ICGf以评估肠灌注。对照组包括在我们机构开始常规使用该工具之前，于2014年1月至2015年4月接受相同手术的同等数量的患者。研究的终点是比较两组之间AL的发生率。两组共纳入33例患者。在吲哚菁绿（ICG）组中，根据荧光强度，我们在6/33例患者（18.2%）中改变了切除水平。ICG组有2/33例患者（6%）发生AL，而对照组有7/33例患者（21.2%）发生AL。常规使用该技术可能有助于外科医生在RAR期间选择近端肠切除的最佳水平。
