Beatriz Martin-Perez, MD, Ana Otero-Piñeiro, MD, Borja DeLacy-Oliver, MD, Romina Pena-Lopez, MD, Maria Clara Arroyave, MD, Maria Fernandez-Hevia, MD, Antonio Lacy, MD. Hospital Clinic
OBJECTIVE: Fluorescence angiography (FA) with indocyanine green (ICG) has demonstrated to help in the evaluation of the microperfusion at gastrointestinal anastomoses. Transanal total mesorectal excisions (taTME) anastomosis have a higher leak risk and the change on surgical plans according to the FA results has decreased the rate of anastomotic leaks. We present our experience using perfusion assessment with the PINPOINT Endoscopic Fluorescence Imaging System ® on taTME for rectal cancer.
METHODS AND PROCEDURES: From our prospectively-maintained database, we identified patients that have undergone ICG assessment from December 2015 to August 2016 (ICG group), and matched with a control group. Leak rate (including anastomotic leakage and perianastomotic collections), overall morbidity, and surgical technique were analyzed.
RESULTS: Twenty patients undergoing taTME for rectal cancer assessed with ICG were identified and matched with 20 control patients (Table 1 and 2), which were not significantly different except for operative time (p=0.028). FA changed surgical plans in 35% patients, with 75% of these changes occurring at the time of transection of the proximal margin, of which only one presented a dehiscence. Anastomotic leak rate on the ICG group was 5% vs 15% ( 3 cases) on the control group (p = 0.08). Overall morbidity rates were 20 vs 35% (p=0.04).
CONCLUSIONS: ICG assessment contributed to decrease the leak rate and overall morbidity on taTME anastomoses, although a larger sample is needed to reach statistical significant values. Therefore, ICG should be considered as a routine assessment for high-risk anastomosis as it guides surgeons for the construction of succesful anastomosis
| ICG | Control | |
|---|---|---|
| Age | 68 | 74 |
| Gender (male) | 13 | 11 |
| BMI | 26 | 25 |
| Distance from anal verge (cm) | 8.9 | 7.2 |
| Neoadjuvancy | 5 | 7 |
| ICG | Control | |
|---|---|---|
| Distance of anastomosis from anal verge (cm) | 4.77 | 3.93 |
| Splenic flexure mobilization | 7 | 6 |
| Mechanic anastomosis | 16 | 12 |
| Diverting ileostomy | 16 | 14 |
| Operative time (min) | 153 | 128 |
| Anastomotic complications | 1 | 3 |
| Overall morbidity | 4 | 7 |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80179
Program Number: P263
Presentation Session: Poster (Non CME)
Presentation Type: Poster
