Evaluation of Colonic Perfusion for Colorectal Cancer Surgery Using Indocyanine Green Fluorescence Imaging
Objective: Anastomotic leakage (AL) is one of the most serious postoperative complications in colorectal surgery. AL reportedly occurs in 5-10% of cases following colorectal surgery. Poor colonic perfusion is proceeded to be AL during mesenteric resection. The purpose of this study was to evaluate t...
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| Published in | Juntendo Iji Zasshi = Juntendo Medical Journal Vol. 67; no. 2; pp. 165 - 172 |
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| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
The Juntendo Medical Society
2021
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| Subjects | |
| Online Access | Get full text |
| ISSN | 2187-9737 2188-2126 2188-2126 |
| DOI | 10.14789/jmj.2021.67.JMJ20-OA11 |
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| Abstract | Objective: Anastomotic leakage (AL) is one of the most serious postoperative complications in colorectal surgery. AL reportedly occurs in 5-10% of cases following colorectal surgery. Poor colonic perfusion is proceeded to be AL during mesenteric resection. The purpose of this study was to evaluate the clinical utility of assessing colonic perfusion with indocyanine green (ICG) fluorescence imaging.Materials and Methods: The subjects comprised 47 patients who underwent colorectal surgery with double-stapling technique anastomosis between March 2015 and September 2016. We measured the time fluorescence first appeared after the ICG injection and the time until maximum fluorescence was measured. These were compared with other clinical findings that correlated with AL.Results: The median first fluorescence time was 43 sec, and the median maximum fluorescence time was 92 sec. Based on the fluorescence imaging, the surgical team judged the proximal colon to be anastomosed insufficiently in 10 patients (21.2%). The median proximal change distance of the transection line was 12.5 mm (5-70). In all 47 patients, AL occurred in 6 patients (12.8%). Maximum fluorescence time (over 98 sec) was significantly longer in the AL group (p=0.025).Conclusions: The results of this study suggested that assessing colonic perfusion using ICG fluorescence imaging during colorectal surgery was clinical useful. It was considered that patients with elongation of fluorescence time should be careful of AL. |
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| AbstractList | Objective: Anastomotic leakage (AL) is one of the most serious postoperative complications in colorectal surgery. AL reportedly occurs in 5-10% of cases following colorectal surgery. Poor colonic perfusion is proceeded to be AL during mesenteric resection. The purpose of this study was to evaluate the clinical utility of assessing colonic perfusion with indocyanine green (ICG) fluorescence imaging.Materials and Methods: The subjects comprised 47 patients who underwent colorectal surgery with double-stapling technique anastomosis between March 2015 and September 2016. We measured the time fluorescence first appeared after the ICG injection and the time until maximum fluorescence was measured. These were compared with other clinical findings that correlated with AL.Results: The median first fluorescence time was 43 sec, and the median maximum fluorescence time was 92 sec. Based on the fluorescence imaging, the surgical team judged the proximal colon to be anastomosed insufficiently in 10 patients (21.2%). The median proximal change distance of the transection line was 12.5 mm (5-70). In all 47 patients, AL occurred in 6 patients (12.8%). Maximum fluorescence time (over 98 sec) was significantly longer in the AL group (p=0.025).Conclusions: The results of this study suggested that assessing colonic perfusion using ICG fluorescence imaging during colorectal surgery was clinical useful. It was considered that patients with elongation of fluorescence time should be careful of AL. [Objective:] Anastomotic leakage (AL) is one of the most serious postoperative complications in colorectal surgery. AL reportedly occurs in 5-10% of cases following colorectal surgery. Poor colonic perfusion is proceeded to be AL during mesenteric resection. The purpose of this study was to evaluate the clinical utility of assessing colonic perfusion with indocyanine green (ICG) fluorescence imaging. [Materials and Methods:] The subjects comprised 47 patients who underwent colorectal surgery with double-stapling technique anastomosis between March 2015 and September 2016. We measured the time fluorescence first appeared after the ICG injection and the time until maximum fluorescence was measured. These were compared with other clinical findings that correlated with AL. [Results:] The median first fluorescence time was 43 sec, and the median maximum fluorescence time was 92 sec. Based on the fluorescence imaging, the surgical team judged the proximal colon to be anastomosed insufficiently in 10 patients (21.2%). The median proximal change distance of the transection line was 12.5 mm (5-70). In all 47 patients, AL occurred in 6 patients (12.8%). Maximum fluorescence time (over 98 sec) was significantly longer in the AL group (p=0.025). [Conclusions:] The results of this study suggested that assessing colonic perfusion using ICG fluorescence imaging during colorectal surgery was clinical useful. It was considered that patients with elongation of fluorescence time should be careful of AL. |
| Author | KAWANO, SHINGO TAKAHASHI, MAKOTO SAKAMOTO, KAZUHIRO SUGIMOTO, KIICHI MOTEGI, SHUNSUKE ISHIYAMA, SHUN TAKEHARA, KAZUHIRO MUNAKATA, SHINYA KOJIMA, YUTAKA TOMIKI, YUICHI |
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| Cites_doi | 10.1007/s00595-013-0685-3 10.1007/s10147-015-0818-3 10.1016/j.jamcollsurg.2014.10.017 10.1016/S0140-6736(08)60455-9 10.1007/s00464-016-5064-x 10.1111/ases.12310 10.1007/s00464-017-5475-3 10.1007/s10350-004-0869-4 10.1007/s10151-017-1731-8 10.1371/journal.pone.0075519 10.1007/s00423-016-1400-9 10.1510/icvts.2008.201418 10.1007/s00268-013-2237-9 10.1007/s00464-016-5181-6 10.1007/s00423-010-0699-x 10.1007/s10350-008-9352-y 10.1007/s00464-013-3377-6 10.1007/s00464-014-3895-x 10.1007/s00384-016-2640-4 10.1002/cncr.23099 10.3748/wjg.v19.i2.185 10.1046/j.0007-1323.2001.01829.x 10.1097/MD.0000000000004386 10.1016/j.jamcollsurg.2008.10.015 10.1016/j.jamcollsurg.2017.11.007 10.1007/s00464-013-2832-8 10.1007/s00464-007-9626-9 10.1007/s10549-010-0760-z 10.1007/s00464-015-4540-z 10.1016/j.jamcollsurg.2014.09.015 |
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| References | 18) Kuroyanagi H, Oya M, Ueno M, Fujimoto Y, Yamaguchi T, Muto T: Standardized technique of laparoscopic intracorporeal rectal transection and anastomosis for low anterior resection. Surg Endosc, 2008; 22: 557-561. 13) Wada T, Kawada K, Takahashi R, et al: ICG fluorescence imaging for quantitative evaluation of colonic perfusion in laparoscopic colorectal surgery. Surg Endosc, 2017; 31: 4184-4193. 14) Blanco-Colino R, Espin-Basany E: Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Tech Coloproctol, 2018; 22: 15-23. 4) Kudszus S, Roesel C, Schachtrupp A, Höer JJ: Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage. Langenbecks Arch Surg, 2010; 395: 1025-1030. 25) Shadad AK, Sullivan FJ, Martin JD, Egan LJ: Gastrointestinal radiation injury: symptoms, risk factors and mechanisms. World J Gastroenterol, 2013; 19: 185-198. 3) Shiomi A, Ito M, Maeda K, et al: Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer: a propensity score matching analysis of 1,014 consecutive patients. J Am Coll Surg, 2015; 220: 186-194. 15) Koyanagi K, Ozawa S, Oguma J, et al: Blood flow speed of the gastric conduit assessed by indocyanine green fluorescence: New predictive evaluation of anastomotic leakage after esophagectomy. Medicine (Baltimore), 2016; 95: e4386. 28) Arimoto A, Uehara K, Tsuzuki T, Aiba T, Ebata T, Nagino M: Role of bevacizumab in neoadjuvant chemotherapy and its influence on microvessel density in rectal cancer. Int J Clin Oncol, 2015; 20: 935-942. 8) Degett TH, Andersen HS, Gogenur I: Indocyanine green fluorescence angiography for intraoperative assessment of gastrointestinal anastomotic perfusion: a systematic review of clinical trials. Langenbecks Arch Surg, 2016; 401: 767-775. 20) Bruce J, Krukowski ZH, Al-Khairy G, Russell EM, Park KG: Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg, 2001; 88: 1157-1168. 23) Hirche C, Murawa D, Mohr Z, et al: ICG fluorescence-guided sentinel node biopsy for axillary nodal staging in breast cancer. Breast Cancer Res Treat, 2010; 121: 373-378. 6) Hellan M, Spinoglio G, Pigazzi A, Lagares-Garcia JA: The influence of fluorescence imaging on the location of bowel transection during robotic left-sided colorectal surgery. Surg Endosc, 2014; 28: 1695-1702. 22) Handa T, Katare RG, Sasaguri S, Sato T: Preliminary experience for the evaluation of the intraoperative graft patency with real color charge-coupled device camera system: an advanced device for simultaneous capturing of color and near-infrared images during coronary artery bypass graft. Interact Cardiovasc Thorac Surg, 2009; 9: 150-154. 1) Kingham TP, Pachter HL: Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am Coll Surg, 2009; 208: 269-278. 19) Watanabe T, Muro K, Ajioka Y, et al: Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol, 2018; 23: 1-34. 11) Boni L, Fingerhut A, Marzorati A, Rausei S, Dionigi G, Cassinotti E: Indocyanine green fluorescence angiography during laparoscopic low anterior resection: results of a case-matched study. Surg Endosc, 2017; 31: 1836-1840. 17) Hasegawa S, Nagayama S, Nomura A, et al: Autonomic nerve-preserving total mesorectal excision in the laparoscopic era. Dis Colon Rectum, 2008; 51: 1279-1282. 27) Nordlinger B, Sorbye H, Glimelius B, et al: Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet, 2008; 371: 1007-1016. 30) Ito T, Obama K, Sato T, et al: Usefulness of transanal tube placement for prevention of anastomotic leakage following laparoscopic low anterior resection. Asian J Endosc Surg, 2017; 10: 17-22. 12) Kawada K, Hasegawa S, Wada T, et al: Evaluation of intestinal perfusion by ICG fluorescence imaging in laparoscopic colorectal surgery with DST anastomosis. Surg Endosc, 2017; 31: 1061-1069. 31) Fujita F, Torashima Y, Kuroki T, Eguchi S: The risk factors and predictive factors for anastomotic leakage after resection for colorectal cancer: reappraisal of the literature. Surgery Today, 2014; 44: 1595-1602. 21) Cong ZJ, Hu LH, Bian ZQ, et al: Systematic review of anastomotic leakage rate according to an international grading system following anterior resection for rectal cancer. PLoS One, 2013; 8: e75519. 9) Boni L, David G, Mangano A, et al: Clinical applications of indocyanine green (ICG) enhanced fluorescence in laparoscopic surgery. Surg Endosc, 2015; 29: 2046-2055. 7) Jafari MD, Wexner SD, Martz JE, et al: Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg, 2015; 220: 82-92.e1. 10) Boni L, David G, Dionigi G, et al: Indocyanine green-enhanced fluorescence to assess bowel perfusion during laparoscopic colorectal resection. Surg Endosc, 2016; 30: 2736-2742. 5) Jafari MD, Lee KH, Halabi WJ, et al: The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery. Surg Endosc, 2013; 27: 3003-3008. 24) Kumagai Y, Ishiguro T, Haga N, Kuwabara K, Kawano T, Ishida H: Hemodynamics of the reconstructed gastric tube during esophagectomy: assessment of outcomes with indocyanine green fluorescence. World J Surg, 2014; 38: 138-143. 26) Koushi K, Nishizawa Y, Kojima M, et al: Association between pathologic features of peripheral nerves and postoperative anal function after neoadjuvant therapy for low rectal cancer. Int J Colorectal Dis, 2016; 31: 1845-1852. 16) Noma K, Shirakawa Y, Kanaya N, et al: Visualized Evaluation of Blood Flow to the Gastric Conduit and Complications in Esophageal Reconstruction. J Am Coll Surg, 2018; 226: 241-251. 29) Ribero D, Wang H, Donadon M, et al: Bevacizumab improves pathologic response and protects against hepatic injury in patients treated with oxaliplatin-based chemotherapy for colorectal liver metastases. Cancer, 2007; 110: 2761-2767. 2) Branagan G, Finnis D, Wessex Colorectal Cancer Audit Working Group: Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum, 2005; 48: 1021-1026. 22 23 24 25 26 27 28 29 30 31 10 11 12 13 14 15 16 17 18 19 1 2 3 4 5 6 7 8 9 20 21 |
| References_xml | – reference: 9) Boni L, David G, Mangano A, et al: Clinical applications of indocyanine green (ICG) enhanced fluorescence in laparoscopic surgery. Surg Endosc, 2015; 29: 2046-2055. – reference: 31) Fujita F, Torashima Y, Kuroki T, Eguchi S: The risk factors and predictive factors for anastomotic leakage after resection for colorectal cancer: reappraisal of the literature. Surgery Today, 2014; 44: 1595-1602. – reference: 28) Arimoto A, Uehara K, Tsuzuki T, Aiba T, Ebata T, Nagino M: Role of bevacizumab in neoadjuvant chemotherapy and its influence on microvessel density in rectal cancer. Int J Clin Oncol, 2015; 20: 935-942. – reference: 20) Bruce J, Krukowski ZH, Al-Khairy G, Russell EM, Park KG: Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg, 2001; 88: 1157-1168. – reference: 26) Koushi K, Nishizawa Y, Kojima M, et al: Association between pathologic features of peripheral nerves and postoperative anal function after neoadjuvant therapy for low rectal cancer. Int J Colorectal Dis, 2016; 31: 1845-1852. – reference: 4) Kudszus S, Roesel C, Schachtrupp A, Höer JJ: Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage. Langenbecks Arch Surg, 2010; 395: 1025-1030. – reference: 21) Cong ZJ, Hu LH, Bian ZQ, et al: Systematic review of anastomotic leakage rate according to an international grading system following anterior resection for rectal cancer. PLoS One, 2013; 8: e75519. – reference: 15) Koyanagi K, Ozawa S, Oguma J, et al: Blood flow speed of the gastric conduit assessed by indocyanine green fluorescence: New predictive evaluation of anastomotic leakage after esophagectomy. Medicine (Baltimore), 2016; 95: e4386. – reference: 7) Jafari MD, Wexner SD, Martz JE, et al: Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg, 2015; 220: 82-92.e1. – reference: 18) Kuroyanagi H, Oya M, Ueno M, Fujimoto Y, Yamaguchi T, Muto T: Standardized technique of laparoscopic intracorporeal rectal transection and anastomosis for low anterior resection. Surg Endosc, 2008; 22: 557-561. – reference: 27) Nordlinger B, Sorbye H, Glimelius B, et al: Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet, 2008; 371: 1007-1016. – reference: 16) Noma K, Shirakawa Y, Kanaya N, et al: Visualized Evaluation of Blood Flow to the Gastric Conduit and Complications in Esophageal Reconstruction. J Am Coll Surg, 2018; 226: 241-251. – reference: 17) Hasegawa S, Nagayama S, Nomura A, et al: Autonomic nerve-preserving total mesorectal excision in the laparoscopic era. Dis Colon Rectum, 2008; 51: 1279-1282. – reference: 23) Hirche C, Murawa D, Mohr Z, et al: ICG fluorescence-guided sentinel node biopsy for axillary nodal staging in breast cancer. Breast Cancer Res Treat, 2010; 121: 373-378. – reference: 29) Ribero D, Wang H, Donadon M, et al: Bevacizumab improves pathologic response and protects against hepatic injury in patients treated with oxaliplatin-based chemotherapy for colorectal liver metastases. Cancer, 2007; 110: 2761-2767. – reference: 6) Hellan M, Spinoglio G, Pigazzi A, Lagares-Garcia JA: The influence of fluorescence imaging on the location of bowel transection during robotic left-sided colorectal surgery. Surg Endosc, 2014; 28: 1695-1702. – reference: 14) Blanco-Colino R, Espin-Basany E: Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Tech Coloproctol, 2018; 22: 15-23. – reference: 19) Watanabe T, Muro K, Ajioka Y, et al: Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol, 2018; 23: 1-34. – reference: 30) Ito T, Obama K, Sato T, et al: Usefulness of transanal tube placement for prevention of anastomotic leakage following laparoscopic low anterior resection. Asian J Endosc Surg, 2017; 10: 17-22. – reference: 24) Kumagai Y, Ishiguro T, Haga N, Kuwabara K, Kawano T, Ishida H: Hemodynamics of the reconstructed gastric tube during esophagectomy: assessment of outcomes with indocyanine green fluorescence. World J Surg, 2014; 38: 138-143. – reference: 25) Shadad AK, Sullivan FJ, Martin JD, Egan LJ: Gastrointestinal radiation injury: symptoms, risk factors and mechanisms. World J Gastroenterol, 2013; 19: 185-198. – reference: 13) Wada T, Kawada K, Takahashi R, et al: ICG fluorescence imaging for quantitative evaluation of colonic perfusion in laparoscopic colorectal surgery. Surg Endosc, 2017; 31: 4184-4193. – reference: 2) Branagan G, Finnis D, Wessex Colorectal Cancer Audit Working Group: Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum, 2005; 48: 1021-1026. – reference: 11) Boni L, Fingerhut A, Marzorati A, Rausei S, Dionigi G, Cassinotti E: Indocyanine green fluorescence angiography during laparoscopic low anterior resection: results of a case-matched study. Surg Endosc, 2017; 31: 1836-1840. – reference: 1) Kingham TP, Pachter HL: Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am Coll Surg, 2009; 208: 269-278. – reference: 3) Shiomi A, Ito M, Maeda K, et al: Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer: a propensity score matching analysis of 1,014 consecutive patients. J Am Coll Surg, 2015; 220: 186-194. – reference: 5) Jafari MD, Lee KH, Halabi WJ, et al: The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery. Surg Endosc, 2013; 27: 3003-3008. – reference: 8) Degett TH, Andersen HS, Gogenur I: Indocyanine green fluorescence angiography for intraoperative assessment of gastrointestinal anastomotic perfusion: a systematic review of clinical trials. Langenbecks Arch Surg, 2016; 401: 767-775. – reference: 10) Boni L, David G, Dionigi G, et al: Indocyanine green-enhanced fluorescence to assess bowel perfusion during laparoscopic colorectal resection. Surg Endosc, 2016; 30: 2736-2742. – reference: 12) Kawada K, Hasegawa S, Wada T, et al: Evaluation of intestinal perfusion by ICG fluorescence imaging in laparoscopic colorectal surgery with DST anastomosis. Surg Endosc, 2017; 31: 1061-1069. – reference: 22) Handa T, Katare RG, Sasaguri S, Sato T: Preliminary experience for the evaluation of the intraoperative graft patency with real color charge-coupled device camera system: an advanced device for simultaneous capturing of color and near-infrared images during coronary artery bypass graft. Interact Cardiovasc Thorac Surg, 2009; 9: 150-154. – ident: 31 doi: 10.1007/s00595-013-0685-3 – ident: 28 doi: 10.1007/s10147-015-0818-3 – ident: 3 doi: 10.1016/j.jamcollsurg.2014.10.017 – ident: 27 doi: 10.1016/S0140-6736(08)60455-9 – ident: 12 doi: 10.1007/s00464-016-5064-x – ident: 30 doi: 10.1111/ases.12310 – ident: 13 doi: 10.1007/s00464-017-5475-3 – ident: 2 doi: 10.1007/s10350-004-0869-4 – ident: 14 doi: 10.1007/s10151-017-1731-8 – ident: 21 doi: 10.1371/journal.pone.0075519 – ident: 8 doi: 10.1007/s00423-016-1400-9 – ident: 22 doi: 10.1510/icvts.2008.201418 – ident: 24 doi: 10.1007/s00268-013-2237-9 – ident: 11 doi: 10.1007/s00464-016-5181-6 – ident: 4 doi: 10.1007/s00423-010-0699-x – ident: 17 doi: 10.1007/s10350-008-9352-y – ident: 6 doi: 10.1007/s00464-013-3377-6 – ident: 9 doi: 10.1007/s00464-014-3895-x – ident: 26 doi: 10.1007/s00384-016-2640-4 – ident: 29 doi: 10.1002/cncr.23099 – ident: 25 doi: 10.3748/wjg.v19.i2.185 – ident: 20 doi: 10.1046/j.0007-1323.2001.01829.x – ident: 15 doi: 10.1097/MD.0000000000004386 – ident: 1 doi: 10.1016/j.jamcollsurg.2008.10.015 – ident: 16 doi: 10.1016/j.jamcollsurg.2017.11.007 – ident: 19 – ident: 5 doi: 10.1007/s00464-013-2832-8 – ident: 18 doi: 10.1007/s00464-007-9626-9 – ident: 23 doi: 10.1007/s10549-010-0760-z – ident: 10 doi: 10.1007/s00464-015-4540-z – ident: 7 doi: 10.1016/j.jamcollsurg.2014.09.015 |
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| Snippet | Objective: Anastomotic leakage (AL) is one of the most serious postoperative complications in colorectal surgery. AL reportedly occurs in 5-10% of cases... [Objective:] Anastomotic leakage (AL) is one of the most serious postoperative complications in colorectal surgery. AL reportedly occurs in 5-10% of cases... |
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| SubjectTerms | anastomotic leakage (AL) colonic perfusion colorectal cancer colorectal surgery ICG fluorescence imaging |
| Title | Evaluation of Colonic Perfusion for Colorectal Cancer Surgery Using Indocyanine Green Fluorescence Imaging |
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