Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
Department of Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan.
Int J Colorectal Dis. 2021 Feb;36(2):395-403. doi: 10.1007/s00384-020-03776-8. Epub 2020 Oct 12.
Several studies have reported the efficacy of near-infrared imaging using indocyanine green in laparoscopic low anterior resection (LAR), but a detailed examination of its fluorescence abnormalities is still insufficient. The purpose of this study was to clarify the incidence of fluorescence abnormalities and to create a new prediction score in laparoscopic LAR.
This was a retrospective, multicenter study that included patients with rectal cancer who underwent laparoscopic LAR from September 2014 to November 2018.
A total of 336 patients were included. The transection line was changed due to fluorescence abnormalities in 5.4% (18/336) of cases, and the median length of additional resection was 70 mm. Anastomotic leakage of Clavien-Dindo grade ≥ II occurred in 6.0% (20/336). The gender and the intraoperative pre-planned proximal margin (IpPM) were significant factors for fluorescence abnormalities. We devised the fluorescence abnormality prediction score (FAPS) derived from the gender, IpPM, and tumor height from the anal verge (TumorAV). The area under the curve of the FAPS was 0.784 (95% CI: 0.677-0.891). When the cutoff was 4, the sensitivity was 0.833, and the specificity was 0.626. The preoperative pre-planned proximal margin (PpPM) was calculated as follows: PpPM (mm) = 189 (mm) - TumorAV (mm) + 61 × Male (1/0). The proximal margin should be set to be larger than the PpPM to avoid fluorescence abnormalities.
The incidence of fluorescence abnormalities in laparoscopic LAR was 5.4%. If the FAPS is used, the PpPM may be set from the viewpoint of the blood perfusion.
Japanese Clinical Trials Registry: UMIN000032654 ( http://www.umin.ac.jp/ctr/index.htm ).
多项研究报告了使用吲哚菁绿进行腹腔镜低位前切除术（LAR）的近红外成像的疗效，但对其荧光异常的详细检查仍不足。本研究旨在阐明荧光异常的发生率，并创建腹腔镜 LAR 的新预测评分。
这是一项回顾性多中心研究，纳入了 2014 年 9 月至 2018 年 11 月期间接受腹腔镜 LAR 的直肠癌患者。
共纳入 336 例患者。由于荧光异常，5.4%（18/336）的患者改变了横断部位，额外切除的中位长度为 70mm。Clavien-Dindo 分级≥Ⅱ级的吻合口漏发生 6.0%（20/336）。性别和术中预设近端切缘（IpPM）是荧光异常的显著因素。我们设计了一种荧光异常预测评分（FAPS），该评分来自性别、IpPM 和距肛门缘的肿瘤高度（TumorAV）。FAPS 的曲线下面积为 0.784（95%CI：0.677-0.891）。当截距为 4 时，灵敏度为 0.833，特异性为 0.626。术前预设近端切缘（PpPM）计算如下：PpPM（mm）=189（mm）-TumorAV（mm）+61×Male（1/0）。为避免荧光异常，近端切缘应设置为大于 PpPM。
腹腔镜 LAR 中荧光异常的发生率为 5.4%。如果使用 FAPS，则可以从血液灌注的角度设置 PpPM。
日本临床试验注册：UMIN000032654（http://www.umin.ac.jp/ctr/index.htm）。
