Prospective analysis of factors influencing the change of the section line based on fluorescence angiography with ICG for colorectal anastomosis.

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Techniques in Coloproctology Pub Date : 2025-06-13 DOI:10.1007/s10151-025-03173-9

J R Gómez-López, A Balla, E Licardie, S Morales-Conde

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引用次数: 0

Abstract

Background: Indocyanine green fluorescence angiography (ICG-FA) in colorectal surgery allows changing the section line (CSL) based on objective evaluation of the vascular supply. The aim of this prospective study is to report our experience with CSL based on ICG-FA during colorectal surgery and to report risk factors influencing it.

Methods: From 2014 to 2023, all patients who underwent any colorectal surgical procedure with anastomosis and ICG-FA were enrolled. Patients for whom changing the section line based on ICG-FA was not necessary were included in group A, and patients for whom ICG-FA determined a CSL were included in group B.

Results: Four hundred consecutive patients underwent laparoscopic surgery, except for two. In 334 patients (group A, 83.5%), CSL based on ICG-FA did not occur, while CSL occurred in 66 patients (group B, 16.5%). In group B, median time from ICG injection and fluorescence visualization (TIFV) was statistically significantly longer than in group A (28.5 s versus 23 s, p = 0.003). Anastomotic leakage rate was 1.8% and 4.5% in group A and B, respectively, without a statistically significant difference. The multivariate logistic regression analysis identified age > 60 years and TIFV ≥ 20 s as independent risk factors for CSL.

Conclusions: Factors influencing the CSL are identified, which could be useful to determine the cases in which this technology should be mandatory and to consider when ICG is not available. These factors could also influence the decision-making process during surgery, such as using protective ileostomy.

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基于ICG荧光血管造影的结肠吻合切线变化影响因素的前瞻性分析。

背景：在结直肠手术中，吲哚菁绿荧光血管造影（ICG-FA）可以根据对血管供应的客观评估改变切线（CSL）。本前瞻性研究的目的是报告我们在结直肠手术中基于ICG-FA的CSL的经验，并报告影响CSL的危险因素。方法：2014年至2023年，所有接受结肠直肠外科手术吻合和ICG-FA的患者均入组。不需要根据ICG-FA改变切片线的患者被纳入A组，ICG-FA确定CSL的患者被纳入b组。结果：除2例外，连续400例患者接受了腹腔镜手术。334例（A组，83.5%）患者未发生基于ICG-FA的CSL，而66例（B组，16.5%）患者发生CSL。B组注射ICG和荧光显示（TIFV）的中位时间比A组长（28.5 s比23 s， p = 0.003），具有统计学意义。A组吻合口漏率1.8%，B组吻合口漏率4.5%，差异无统计学意义。多因素logistic回归分析发现年龄≥60岁和TIFV≥20 s是CSL的独立危险因素。结论：确定了影响CSL的因素，这可能有助于确定在哪些情况下应该强制使用该技术，并在无法使用ICG时进行考虑。这些因素也会影响手术中的决策过程，例如使用保护性回肠造口术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.