Wenlong Qiu, Junguang Liu, Kunshan He, Gang Hu, Shiwen Mei, Xu Guan, Xishan Wang, Jie Tian, Jianqiang Tang
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A total of 556 consecutive patients with ultra-low rectal cancer including 140 patients with fluorescence angiography of epiploic appendages (FAEA)were enrolled. Perfusion assessment by FAEA in the monochrome fluorescence mode. Patients were divided into two groups based on perfusion assessment by FAEA. The primary endpoint was the AL rate within 6 months, and the secondary endpoint was the structural sequelae of anastomotic leakage (SSAL).</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>After matching, the study group (<i>n</i> = 109) and control group (<i>n</i> = 190) were well-balanced. The AL rate in the FAEA group was lower before (3.6% vs. 10.1%, <i>P</i> = 0.026) and after matching (3.7% vs. 10.5%, <i>P</i> = 0.036). Propensity scores matching analysis (OR 0.275, 95% CI 0.035–0.937, <i>P </i>0.039), inverse probability of treatment weighting (OR 0.814, 95% CI 0.765–0.921, <i>P </i>0.002), and regression analysis (OR 0.298, 95% CI 0.112–0.790, <i>P</i> = 0.015), showed that FAEA was an independent protector factor for AL. This technique can significantly shorten postoperative hospital stay [9 (6–13) vs. 10 (8–13), <i>P</i> = 0.024] and reduce the risk of SSAL (1.4% vs. 6.0%, <i>P</i> = 0.029).</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Perfusion assessment by FAEA can achieve better visualization in LsISR and reduce the incidence of AL, subsequently avoiding SSAL after LsISR.</p>","PeriodicalId":501625,"journal":{"name":"Surgical Endoscopy","volume":"34 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Blood perfusion assessment by near-infrared fluorescence angiography of epiploic appendages in prevention of anastomotic leakage after laparoscopic intersphincteric resection for ultra-low rectal cancer: a case-matched study\",\"authors\":\"Wenlong Qiu, Junguang Liu, Kunshan He, Gang Hu, Shiwen Mei, Xu Guan, Xishan Wang, Jie Tian, Jianqiang Tang\",\"doi\":\"10.1007/s00464-024-11085-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<h3 data-test=\\\"abstract-sub-heading\\\">Background</h3><p>The role of intraoperative near-infrared fluorescence angiography with indocyanine green in reducing anastomotic leakage (AL) has been demonstrated in colorectal surgery, however, its perfusion assessment mode, and efficacy in reducing anastomotic leakage after laparoscopic intersphincteric resection (LsISR) need to be further elucidated.</p><h3 data-test=\\\"abstract-sub-heading\\\">Aim</h3><p>Aim was to study near-infrared fluorescent angiography to help identify bowel ischemia to reduce AL after LsISR.</p><h3 data-test=\\\"abstract-sub-heading\\\">Material and methods</h3><p>A retrospective case-matched study was conducted in one referral center. A total of 556 consecutive patients with ultra-low rectal cancer including 140 patients with fluorescence angiography of epiploic appendages (FAEA)were enrolled. Perfusion assessment by FAEA in the monochrome fluorescence mode. Patients were divided into two groups based on perfusion assessment by FAEA. The primary endpoint was the AL rate within 6 months, and the secondary endpoint was the structural sequelae of anastomotic leakage (SSAL).</p><h3 data-test=\\\"abstract-sub-heading\\\">Results</h3><p>After matching, the study group (<i>n</i> = 109) and control group (<i>n</i> = 190) were well-balanced. The AL rate in the FAEA group was lower before (3.6% vs. 10.1%, <i>P</i> = 0.026) and after matching (3.7% vs. 10.5%, <i>P</i> = 0.036). Propensity scores matching analysis (OR 0.275, 95% CI 0.035–0.937, <i>P </i>0.039), inverse probability of treatment weighting (OR 0.814, 95% CI 0.765–0.921, <i>P </i>0.002), and regression analysis (OR 0.298, 95% CI 0.112–0.790, <i>P</i> = 0.015), showed that FAEA was an independent protector factor for AL. 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引用次数: 0
摘要
背景术中吲哚菁绿近红外荧光血管造影在减少吻合口漏（AL）方面的作用已在结直肠手术中得到证实，然而，其灌注评估模式以及在减少腹腔镜括约肌间切除术（LsISR）后吻合口漏方面的功效仍有待进一步阐明。材料和方法在一家转诊中心进行了一项回顾性病例匹配研究。共纳入了 556 例超低位直肠癌患者，其中 140 例患者接受了外膜阑尾荧光血管造影术（FAEA）。通过单色荧光模式下的 FAEA 进行灌注评估。根据 FAEA 的灌注评估结果将患者分为两组。主要终点是 6 个月内的 AL 率，次要终点是吻合口漏的结构性后遗症（SSAL）。结果经过配对，研究组（109 人）和对照组（190 人）非常均衡。在匹配前（3.6% 对 10.1%，P = 0.026）和匹配后（3.7% 对 10.5%，P = 0.036），FAEA 组的 AL 率较低。倾向评分匹配分析（OR 0.275，95% CI 0.035-0.937，P 0.039）、治疗加权逆概率（OR 0.814，95% CI 0.765-0.921，P 0.002）和回归分析（OR 0.298，95% CI 0.112-0.790，P = 0.015）显示，FAEA 是 AL 的独立保护因素。该技术可明显缩短术后住院时间[9 (6-13) vs. 10 (8-13)，P = 0.024]，降低 SSAL 风险（1.4% vs. 6.0%，P = 0.029）。
Blood perfusion assessment by near-infrared fluorescence angiography of epiploic appendages in prevention of anastomotic leakage after laparoscopic intersphincteric resection for ultra-low rectal cancer: a case-matched study
Background
The role of intraoperative near-infrared fluorescence angiography with indocyanine green in reducing anastomotic leakage (AL) has been demonstrated in colorectal surgery, however, its perfusion assessment mode, and efficacy in reducing anastomotic leakage after laparoscopic intersphincteric resection (LsISR) need to be further elucidated.
Aim
Aim was to study near-infrared fluorescent angiography to help identify bowel ischemia to reduce AL after LsISR.
Material and methods
A retrospective case-matched study was conducted in one referral center. A total of 556 consecutive patients with ultra-low rectal cancer including 140 patients with fluorescence angiography of epiploic appendages (FAEA)were enrolled. Perfusion assessment by FAEA in the monochrome fluorescence mode. Patients were divided into two groups based on perfusion assessment by FAEA. The primary endpoint was the AL rate within 6 months, and the secondary endpoint was the structural sequelae of anastomotic leakage (SSAL).
Results
After matching, the study group (n = 109) and control group (n = 190) were well-balanced. The AL rate in the FAEA group was lower before (3.6% vs. 10.1%, P = 0.026) and after matching (3.7% vs. 10.5%, P = 0.036). Propensity scores matching analysis (OR 0.275, 95% CI 0.035–0.937, P 0.039), inverse probability of treatment weighting (OR 0.814, 95% CI 0.765–0.921, P 0.002), and regression analysis (OR 0.298, 95% CI 0.112–0.790, P = 0.015), showed that FAEA was an independent protector factor for AL. This technique can significantly shorten postoperative hospital stay [9 (6–13) vs. 10 (8–13), P = 0.024] and reduce the risk of SSAL (1.4% vs. 6.0%, P = 0.029).
Conclusions
Perfusion assessment by FAEA can achieve better visualization in LsISR and reduce the incidence of AL, subsequently avoiding SSAL after LsISR.
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