Clinical value of fluorescence laparoscopic surgery on anastomotic leakage prevention in ultra-low rectal cancer: real-world multicenter retrospective evidence with neoadjuvant chemoradiotherapy stratification.

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Techniques in Coloproctology Pub Date : 2025-08-21 DOI:10.1007/s10151-025-03203-6

W Qiu, G Hu, K He, S Mei, Z Xing, Y Li, J Tang

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引用次数: 0

Abstract

Background: Neoadjuvant chemoradiotherapy (nCRT) is key for low rectal cancer but raises the risk of anastomotic leakage (AL). This study examines how fluorescence laparoscopic (FL) surgery reduces AL after intersphincteric resection (ISR), especially in nCRT patients.

Methods: This real-world multicenter cohort study included 533 patients undergoing laparoscopic ISR for ultra-low rectal adenocarcinoma from January 2012 to July 2023. Patients were categorized into FL and non-FL groups. Propensity score matching (PSM) was used at a 1:2 ratio to adjust for baseline differences. The primary endpoint was the incidence of AL within 6 months postoperatively. Secondary endpoints included anastomotic site perfusion, intraoperative blood loss, lymph node retrieval, perioperative complications, and postoperative recovery metrics. Subgroup analyses were conducted on the basis of nCRT status.

Results: After PSM, 393 patients were analyzed (131 FL versus 262 non-FL). The FL group showed a significantly lower AL incidence (3.1% versus 11.5%, P = 0.005), with fewer severe symptomatic AL cases (0.8% versus 6.1%, P = 0.014). Intraoperative blood loss was reduced (45.2 ± 58.9 mL versus 65.3 ± 73.1 mL, P = 0.004), and lymph node yield was higher (21.2 ± 11.4 versus 16.6 ± 7.3, P < 0.001) in the FL group. Postoperative recovery was accelerated, with earlier return of bowel function and shorter hospital stays (9.5 ± 3.1 versus 10.7 ± 3.8 days, P = 0.012). In subgroup analyses, FL significantly reduced AL rates in patients without nCRT (1.9% versus 7.2%, P = 0.045) and demonstrated a strong trend toward reduction in AL for patients receiving nCRT (13.0% versus 35.9%, P = 0.051). FL also increased the proportion of patients achieving benchmark lymph node retrieval, including those post-nCRT.

Conclusions: Fluorescence-guided laparoscopic surgery reduces anastomotic leakage and improves outcomes in low rectal cancer, especially after chemoradiotherapy, by enhancing surgical precision and recovery.

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荧光腹腔镜手术预防超低位直肠癌吻合口漏的临床价值：新辅助放化疗分层多中心回顾性证据

背景：新辅助放化疗（nCRT）是低位直肠癌的关键，但会增加吻合口漏（AL）的风险。本研究探讨了荧光腹腔镜（FL）手术如何减少括约肌间切除术（ISR）后的AL，特别是在nCRT患者中。方法：这项真实世界的多中心队列研究包括533例2012年1月至2023年7月接受腹腔镜下超低直肠腺癌ISR治疗的患者。患者分为FL组和非FL组。倾向得分匹配（PSM）以1:2的比例调整基线差异。主要终点是术后6个月内AL的发生率。次要终点包括吻合口灌注、术中出血量、淋巴结回收、围手术期并发症和术后恢复指标。根据nCRT状态进行亚组分析。结果：PSM后，393例患者进行了分析（131例FL vs 262例非FL）。FL组AL发病率显著降低（3.1%比11.5%,P = 0.005），严重症状AL病例较少（0.8%比6.1%,P = 0.014）。术中出血量减少（45.2±58.9 mL比65.3±73.1 mL, P = 0.004），淋巴结清扫率提高（21.2±11.4 mL比16.6±7.3 mL, P = 0.004）。结论：荧光引导下腹腔镜手术通过提高手术精度和术后恢复，减少低位直肠癌吻合口漏，改善预后，特别是放化疗后。

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.