Evaluation of the intestinal blood flow near the rectosigmoid junction using the indocyanine green fluorescence method in a colorectal cancer surgery

It has been reported that some patients do not have an anastomosis of a marginal artery near the rectosigmoid junction, but the frequency of this condition and its clinical significance so far remain unclear. The aim of this study was to evaluate the blood flow at the marginal artery near the rectosigmoid junction. From January 2013 to January 2014, we enrolled consecutive patients with a preoperative diagnosis of left-sided colon cancer or rectal cancer who underwent surgery with lymph node dissection. During the operation, the blood flow through the point of origin of the last sigmoid arterial branch, originating from the inferior mesenteric artery, was interrupted, and the rectosigmoid junction was supplied by only the marginal artery. We injected indocyanine green intravenously and observed the blood flow using a near-infrared camera system. A total of 119 consecutive patients were enrolled in this study. Sixty-eight patients (57.1 %) had a good anastomosis of the marginal artery near the rectosigmoid junction (type A). In 27 patients (22.7 %), a fluorescence border was recognized, but the fluorescence border diminished within 60 s (Type B). In 18 patients (15.1 %), delayed fluorescence was recognized over 60 s (type C), and 6 patients (5.0 %) had no fluorescence at all (type D). A mean length of 14.8 cm was found from the peritoneal reflection to fluorescence border of blood flow. This study proves that cases without the anastomosis of the marginal artery of the rectosigmoid junction truly exist, using studies in living humans (UMIN000011186).