Anastomotic diversion rates following integration of indocyanine green fluorescence angiography in cytoreductive surgery for ovarian cancer.

Objective: To compare rates of diverting ileostomy in patients with ovarian cancer, undergoing cytoreduction with bowel resection before and after the acquisition of indocyanine green fluorescence angiographic scans for anastomotic perfusion assessment.

Methods: A retrospective cohort study of patients with ovarian cancer undergoing bowel resection during cytoreductive surgery between 2010 and 2021. We evaluated whether using indocyanine green fluorescence angiography impacted rates of diverting ileostomy. Baseline characteristics and rates of diversion were compared between those who had indocyanine green fluorescence assessment and those with bowel resection without anastomotic fluorescence assessment.

Results: Overall, 181 patients were included. Of whom, 84 (46%) underwent anastomotic fluorescence assessment following bowel resection, and 97 (54%) had bowel resection without assessment. Mean age of the cohort was 58.2 years and 132 (73%) had stage III disease. There was no difference between groups in rates of diverting ileostomy (41% vs 41%, p=1.0). In a univariable logistic regression, the odds of having an ileostomy were 2.92 times higher in patients undergoing primary surgery than in patients undergoing interval cytoreductive surgery (95% CI 1.25 to 6.85, p=0.013). The use of fluorescence angiography did not predict performing diverting ileostomy (OR=0.97, 95% CI (0.53 to 1.76), p=0.92).

Conclusion: In this cohort, the simple introduction of indocyanine green fluorescence angiography had no impact on the rates of anastomotic diversion. Developing a systematic, reproducible diversion protocol with selection criteria that include fluorescence angiography is needed to assess the impact of this surgically innovative tool on the rates of anastomotic diversion in patients with advanced ovarian cancer.