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Erschienen in: Surgical Endoscopy 10/2020

18.06.2020 | Review Article

Intraoperative use of fluorescence with indocyanine green reduces anastomotic leak rates in rectal cancer surgery: an individual participant data analysis

verfasst von: Alberto Arezzo, Marco Augusto Bonino, Frédéric Ris, Luigi Boni, Elisa Cassinotti, Dominic Chi Chung Foo, Nga Fan Shum, Alberto Brolese, Francesco Ciarleglio, Deborah S. Keller, Riccardo Rosati, Paola De Nardi, Ugo Elmore, Uberto Fumagalli Romario, Mehraneh Dorna Jafari, Alessio Pigazzi, Evgeny Rybakov, Mikhail Alekseev, Jun Watanabe, Nereo Vettoretto, Roberto Cirocchi, Roberto Passera, Edoardo Forcignanò, Mario Morino

Erschienen in: Surgical Endoscopy | Ausgabe 10/2020

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Abstract

Background

Fluorescence imaging by means of Indocyanine green (ICG) has been applied to intraoperatively determine the perfusion of the anastomosis. The purpose of this Individual Participant Database meta-analysis was to assess the effectiveness in decreasing the incidence of anastomotic leak (AL) after rectal cancer surgery.

Methods

We searched PubMed, Embase, Cochrane Library and ClinicalTrial.gov, EU Clinical Trials and ISRCTN registries on September 1st, 2019. We considered eligible those studies comparing the assessment of anastomotic perfusion during rectal cancer surgery by intraoperative use of ICG fluorescence compared with standard practice. We defined as primary outcome the incidence of AL at 30 days after surgery. The studies were assessed for quality by means of the ROBINS-I and the Cochrane risk tools. We calculated odds ratios (ORs) using the Individual patient data analysis, restricted to rectal lesions, according to original treatment allocation.

Results

The review of the literature and international registries produced 15 published studies and 5 ongoing trials, for 9 of which the authors accepted to share individual participant data. 314 patients from two randomized trials, 452 from three prospective series and 564 from 4 non-randomized studies were included. Fluorescence imaging significantly reduced the incidence of AL (OR 0.341; 95% CI 0.220–0.530; p < 0.001), independent of age, gender, BMI, tumour and anastomotic distance from the anal verge and neoadjuvant therapy. Also, overall morbidity and reintervention rate were positively influenced by the use of ICG.

Conclusions

The incidence of AL may be reduced when ICG fluorescence imaging is used to assess the perfusion of a colorectal anastomosis. Limitations relate to the consistent number of non-randomized studies included and their heterogeneity in defining and assessing AL. Ongoing large randomized studies will help to determine the exact role of routine ICG fluorescence imaging may decrease the incidence of AL in surgery for rectal cancer.
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Metadaten
Titel
Intraoperative use of fluorescence with indocyanine green reduces anastomotic leak rates in rectal cancer surgery: an individual participant data analysis
verfasst von
Alberto Arezzo
Marco Augusto Bonino
Frédéric Ris
Luigi Boni
Elisa Cassinotti
Dominic Chi Chung Foo
Nga Fan Shum
Alberto Brolese
Francesco Ciarleglio
Deborah S. Keller
Riccardo Rosati
Paola De Nardi
Ugo Elmore
Uberto Fumagalli Romario
Mehraneh Dorna Jafari
Alessio Pigazzi
Evgeny Rybakov
Mikhail Alekseev
Jun Watanabe
Nereo Vettoretto
Roberto Cirocchi
Roberto Passera
Edoardo Forcignanò
Mario Morino
Publikationsdatum
18.06.2020
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 10/2020
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07735-w

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