Gyung Mo Son, MD. Pusan National University Yangsan Hospital
Purpose: This study is to evaluate quantitative analysis of colon perfusion pattern using ICG angiography to find the most reliable predictive factor for perfusion status and anastomotic complications after laparoscopic colorectal surgery.
Methods: Fluorescence imaging system (IMAGE1 S™, Karl Storz, Germany) was applied to colorectal cancer patients (n=46) from July, 2015 to May, 2017. Fluorescence intensity of colonic flow was measured sequentially to draw perfusion graph using video analysis and modeling tool (Tracker 4.97, Douglas Brown, open source physics, Boston MA, USA). Colonic perfusion patterns were categorized to fast, moderate, and slow groups based on Fluorescence Slope (FS) of ICG graph. ICG perfusion parameters were analyzed and compared with colonic perfusion status and anastomotic complications.
Results: Mean age was 65 years and male to female ratio was 32:14. Operations were laparoscopic low anterior resection (32 cases) and anterior resection (14 cases). Incidence of anastomotic complication was 10.9% including stricture (n=1), leak (n=3), colonic necrosis (n=1) and reoperations were needed for 3 cases (6.5%). Anastomotic complications were significantly related with perfusion pattern as fast (FS>0.7, 2.6%), moderate (0.5≤FS≤0.7, 25%), and slow (FS<0.5, 75%) groups. Slow perfusion (FS<0.5) was independent factor for anastomotic complications on logistic regression model (Exp(B); 0.017, 95% C.I.; 0.001~0.241, p=0.003). Atherosclerosis factors (≥3 factors), visceral obesity, ASA (≥3), and DM were associated with slow perfusion. On quantitative analysis, Tmax, T1/2max, and perfusion time ratio (TR=T1/2max/Tmax) reflected perfusion pattern significantly. Cutoff value of TR was analyzed as 0.6 to predict anastomotic complications through ROC curve analysis (AUC 0.976, P=0.002). Anastomotic complications were significantly related with TR (>0.6) as the novel and most reliable predictive factor of perfusion and anastomotic complications (p<0.001).
Conclusion: Quantitative analysis of ICG perfusion pattern could be applied to detect poor perfusion segment for optimal anastomosis and to reduce anastomotic complications during laparoscopic colorectal surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86507
Program Number: S058
Presentation Session: Instrumentation / Devices / Technologies Session
Presentation Type: Podium