Impact of near-infrared fluorescence imaging with indocyanine green on structural sequelae of anastomotic leakage after laparoscopic intersphincteric resection of malignant rectal tumors

医学 吲哚青绿 外科 结直肠外科 吻合 切除术 腹腔镜检查 腹部外科 放射科
作者
Hiro Hasegawa,Yuichiro Tsukada,Masashi Wakabayashi,Shogo Nomura,Takeshi Sasaki,Yuji Nishizawa,Koji Ikeda,Nobuyoshi Takeshita,Koichi Teramura,Masaaki Ito
出处
期刊:Techniques in Coloproctology [Springer Science+Business Media]
卷期号:26 (7): 561-570 被引量:4
标识
DOI:10.1007/s10151-022-02631-y
摘要

BackgroundRecent studies have indicated the potential benefit of intraoperative near-infrared fluorescence imaging (NIR-FI) with indocyanine green in reducing early anastomotic leakage in colorectal surgery. Nonetheless, whether NIR-FI is effective in reducing structural sequelae of anastomotic leakage (SSAL) remains unclear. The aim of the present study was to investigate the impact of NIR-FI on SSAL after laparoscopic intersphincteric resection (ISR) of malignant rectal tumors.MethodsThis study was a retrospective single-center cohort study. A total of 293 consecutive patients who underwent elective laparoscopic ISR from May 2010 to August 2017 were included. Patients were divided into 2 groups; those who underwent elective laparoscopic ISR with lymphadenectomy for malignant rectal tumors using NIR-F (NIR-FI group) and those who underwent elective laparoscopic ISR with lymphadenectomy for malignant rectal tumors without using NIR-FI (control group). Thirty were excluded from the analyses (13 died, 7 had pelvic recurrence, and 10 were lost to follow-up). The primary endpoint was the rate of SSAL within 2 years after the primary resection, whereas the secondary endpoint was the rate of natural defecation via the anus at 2 years after the primary resection. Using various statistical analyses, such as propensity score matching, the rate of SSAL was compared between groups.ResultsA total of 263 patients were analyzed [177 males and 86 females, median age 61 (27–84) years]. Prior to propensity score matching (n = 263), NIR-FI was performed in 70 patients (26.6%) The rates of SSAL were 1.4% (1/70) in the NIR-FI group and 10.4% (20/193) in the control group (p = 0.02). After propensity score matching (n = 163), the rates of SSAL were 1.5% (1/66) in the NIR-FI group and 11.7% (12/103) in the control group (p = 0.02). Propensity score analyses, as well as simple regression analyses, revealed that NIR-FI was associated with a significantly lower risk of SSAL (OR 0.10–0.13; p = 0.03–0.05).ConclusionsNIR-FI is useful in reducing the rate of SSAL after laparoscopic ISR.
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