Colon Rectal Surgery Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
Colon Rectal Surgery Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
Anticancer Res. 2022 Jan;42(1):211-216. doi: 10.21873/anticanres.15475.
Anastomotic leakage represents the most fearful complication in colorectal surgery. Important risk factors for leakage are low anastomoses and preoperative radiotherapy. Many surgeons often unnecessarily perform a protective ileostomy, increasing costs and necessitating a second operation for recanalization. The aim of this study was to evaluate the role of indocyanine green in assessing bowel perfusion, even in cases of a low anastomosis on tissue treated with radiotherapy.
Two groups of patients were selected: Group A (risky group) with only low extraperitoneal rectal tumors (<8 cm) previously treated with neoadjuvant chemo-radiotherapy; group B (no risk group) with only intraperitoneal rectal tumors (>8 cm), not previously treated with neoadjuvant therapy. Clinical postoperative outcome, morbidity, mortality and anastomotic leakage were compared between these two groups.
In group A, comprised of 35 patients, the overall complication rate was 8.6%, with two patients developing anastomotic leakage (5.7%). In group B, comprised of 53 patients, the overall complication rate was 17% with four cases with anastomotic leakage (7.5%). No statistical difference was observed for conversion rate, general complications, or anastomotic leakage. No statistical differences were observed in clinical variables except for American Society of Anesthesiologist score (p=0.04). Patients who developed complications during radiotherapy had no significant differences in postoperative outcomes compared with other patients.
Indocyanine green appears to be safe and effective in assessing the perfusion of colorectal anastomoses, even in the highest-risk cases, potentially reducing the rate of ileostomy. The main limitation remains the lack of a universally replicable standard assessment.
吻合口漏是结直肠手术中最可怕的并发症。吻合口位置低和术前放疗是吻合口漏的重要危险因素。许多外科医生经常不必要地进行保护性回肠造口术，增加了成本，并需要进行第二次再通手术。本研究的目的是评估吲哚菁绿在评估肠灌注中的作用，即使在接受放疗的组织中存在低位吻合口的情况下也是如此。
选择了两组患者：A 组（高危组）仅包括低位腹膜外直肠肿瘤（<8cm），且先前接受过新辅助放化疗；B 组（无风险组）仅包括腹膜内直肠肿瘤（>8cm），且先前未接受新辅助治疗。比较两组患者的临床术后结局、发病率、死亡率和吻合口漏。
A 组 35 例患者中，总并发症发生率为 8.6%，2 例发生吻合口漏（5.7%）。B 组 53 例患者中，总并发症发生率为 17%，4 例发生吻合口漏（7.5%）。转换率、一般并发症或吻合口漏无统计学差异。除美国麻醉师协会评分（p=0.04）外，临床变量无统计学差异。接受放疗的患者与其他患者的术后结局无显著差异。
吲哚菁绿在评估结直肠吻合口的灌注方面似乎是安全有效的，即使在风险最高的情况下，也可能降低回肠造口术的发生率。主要限制仍然是缺乏普遍可复制的标准评估。
