Journal
DISEASES OF THE COLON & RECTUM
Volume 60, Issue 4, Pages 376-384Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/DCR.0000000000000782
Keywords
Indocyanine green; Perfusion imaging guideline; Robot-assisted; Sphincter-saving operation
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Funding
- Korea Research Foundation [2013R1A2A1A03070986]
- Ministry of Science, ICT, and Future Planning
- Korea Health 21 RD Project [HI06C0868, HI13C1750]
- Ministry of Health, Welfare, and Family Affairs, Republic of Korea
- National Research Foundation of Korea [2013R1A2A1A03070986] Funding Source: Korea Institute of Science & Technology Information (KISTI), National Science & Technology Information Service (NTIS)
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BACKGROUND: Since the introduction of indocyanine green angiography more than 25 years ago, few studies have presented interpretative guidelines for indocyanine green fluorescent imaging. OBJECTIVE: We aimed to provide interpretative guidelines for indocyanine green fluorescent imaging through quantitative analysis and to suggest possible indications for indocyanine green fluorescent imaging during robot-assisted sphincter-saving operations. DESIGN: This is a retrospective observational study. SETTINGS: This study was conducted at a single center. PATIENTS: A cohort of 657 patients with rectal cancer who consecutively underwent curative robot-assisted sphincter-saving operations was enrolled between 2010 and 2016, including 310 patients with indocyanine green imaging (indocyanine green fluorescent imaging+group) and 347 patients without indocyanine green imaging (indocyanine green fluorescent imaginggroup). MAIN OUTCOME MEASURES: We tried to quantitatively define the indocyanine green fluorescent imaging findings based on perfusion (mesocolic and colic) time and perfusion intensity (5 grades) to provide probable indications. RESULTS: The anastomotic leakage rate was significantly lower in the indocyanine green fluorescent imaging+ group than in the indocyanine green fluorescent imaging-group (0.6% vs 5.2%) (OR, 0.123; 95% CI, 0.028-0.544; p = 0.006). Anastomotic stricture was closely correlated with anastomotic leakage (p = 0.002) and a short descending mesocolon (p = 0.003). Delayed perfusion (> 60 s) and low perfusion intensity (1-2) were more frequently detected in patients with anastomotic stricture and marginal artery defects than in those without these factors (p <= 0.001). In addition, perfusion times greater than the mean were more frequently observed in patients aged > 58 years, whereas low perfusion intensity was seen more in patients with short descending mesocolon and high ASA classes (>= 3). LIMITATIONS: The 300 patients in the indocyanine green fluorescent imaging-group underwent operations 3 years before indocyanine green fluorescent imaging. CONCLUSIONS: Quantitative analysis of indocyanine green fluorescent imaging may help prevent anastomotic complications during robot-assisted sphincter-saving operations, and may be of particular value in high-class ASA patients, older patients, and patients with a short descending mesocolon.
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