Takeshi Yanagita, MD, Masayasu Hara, Korehito Takasu, Yuzo Maeda, Nozomu Nakai, Takahisa Hirokawa, Kazuyoshi Shiga, Hiroki Takahashi, Yoichi Matsuo, Shuji Takiguchi. Nagoya City University
Introduction: Postoperative anastomotic leakage (AL) is still one of the most devastating complications after surgery. Not only causing severe postoperative general conditions, but also AL leads to oncological poorer prognosis. Previous investigations have already revealed several risk factors, among which, intestinal perfusion at anastomotic site is thought to be one of the most influential factors. ICG fluorescence imaging made it possible to visualize tissue perfusion more clearly. Although resent studies have shown a promising result, studies with relatively small number of patients are available so far, and no report have demonstrated its efficacy statistically. we evaluated its efficacy in terms of decreasing the incidence of AL in patients with left-sided colon or rectal cancer by comparing with those without ICG assessment.
Methods: A single-center, observational study was performed in consecutive 130 patients with left-sided colon or rectal cancer who underwent ICG fluorescence imaging during elective operations from March 2015 to December 2017 (group I). On the other hand, 130 patients who had similar diagnoses and procedures as ICG group from November 2013 to February 2015 were reviewed on charts as a historical control group (group C).
Data was analyzed using inverse probability of treatment weighting based on propensity scores to control for bias and the efficacy of ICG fluorescence imaging were assessed via a weighted Cox proportional hazards model in addition to number needed to treat (NNT).
Results: Patients’ characteristics like age, gender, BMI etc. were comparable between both groups, except tumor location and preoperative chemoradiation therapy (CRT).
The number of cases with rectal cancer and CRT was statistically larger in group I than group C, which led to the significant difference of anastomotic technique (double stapling technique was preferred in group I) . Planned transactional line of colon was changed in thirteen patients after ICG assessment because of suspicious poor blood flow. Symptomatic AL occurred in 5 patients (3.8%) in group I and in 11 patients (8.5%) in group C with weighted P value of 0.073 and NNT was calculated to 17.9. It was evaluated that 315 cases in each group were necessary to show the significant difference from the weighted data.
Conclusion: In conclusion, this study demonstrates ICG assessment had tendency to decrease AL, and could be beneficial for at least one in every eighteen patients from the result of NNT. Additional 200 cases in each arm are necessary to prove statistical significance in terms of preventing AL.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94524
Program Number: P326
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster