Indocyanine Green Dye Fluorescence Imaging and Colorectal Cancer Anastomotic Leak Rate: A Narrative review

Document Type : Narrative Review

Authors

1 Department of Gastrointestinal Surgical Oncology Tata Memorial Hospital, Mumbai 400012, India

2 Colorectal Division, Department of GI & HPB Surgery, Tata Memorial Centre, Homi Bhabha National Institute Mumbai, India 400012

Abstract

Anastomotic leak is a significant morbidity in colorectal surgeries. The risk factors for anastomotic leakage are multifactorial with vascularity of the bowel edge playing an important role. ICG (Indocyanine green) dye emits fluorescence and this principle is used to assess the bowel edge vascularity before anastomosis. The context of the study is that even though ICG dye is being utilized in colorectal cancer surgery for quite a while the evidence is not strong. Most of the data on the role of ICG dye in decreasing the anastomotic leak rate in colorectal cancer surgery comes from retrospective and few prospective trials. There are a few recently published randomized controlled trials (RCT) with contrasting outcomes in this regard. PubMed, Embase and Scopus databases were searched with the keywords Indocyanine green AND Colorectal surgery AND Anastomotic leak for RCTs published till 31st December 2023. Of the total number of search results, four completed RCTs were found and were included in this review. The results of the RCTs are discussed with a critical eye in the text. This narrative review is an attempt to understand the outcomes of the published RCTs with reviewing the variables of the study population of these studies and their applicability in real world clinical scenarios. To conclude, the role of ICG dye is not well established in reducing anastomotic leak rates following colorectal anastomosis, but there is growing evidence to support its use.

Keywords

References

1. Park JS, Choi GS, Kim SH, Kim
HR, K im N K, L ee K Y, e t a l.
Multicenter analysis of risk factors
for anastomotic leakage after
laparoscopic rectal cancer excision:
the Korean laparoscopic colorectal
surgery study group. Annals of
surgery. 2013;257(4):665-71.
2. Kang CY, Halabi WJ, Chaudhry OO,
Nguyen V, Pigazzi A, Carmichael JC,
et al. Risk factors for anastomotic
leakage after anterior resection
for rectal cancer. JAMA surgery.
2013;148(1):65-71.
3. Kingham TP, Pachter HL. Colonic
anastomotic leak: risk factors,
diagnosis, and treatment. Journal of
the American College of Surgeons.
2009;208(2):269-78.
4. Urbanavičius L, Pattyn P, de Putte
DV, Venskutonis D. How to assess
intestinal viability during surgery:
A review of techniques. World
journal of gastrointestinal surgery.
2011;3(5):59-69.
5. Karliczek A, Harlaar NJ, Zeebregts
CJ, Wiggers T, Baas PC, van Dam
GM. Surgeons lack predictive
accuracy for anastomotic leakage in
gastrointestinal surgery. International
journal of colorectal disease.
2009;24(5):569-76.
6. Garoufalia Z, Wexner SD. Indocyanine
Green Fluorescence Guided Surgery
in Colorectal Surgery. Journal of
clinical medicine. 2023;12(2).
7. Spinoglio G, Bertani E, Borin S,
Piccioli A, Petz W. Green indocyanine
fluorescence in robotic abdominal
surgery. Updates in Surgery.
2018;70(3):375-9.
8. Jafari MD, Pigazzi A, McLemore EC,
Mutch MG, Haas E, Rasheid SH, et al.
Perfusion Assessment in Left-Sided/
Low Anterior Resection (PILLAR
III): A Randomized, Controlled,
Parallel, Multicenter Study Assessing
Perfusion Outcomes With PINPOINT
Near-Inf rared Fluorescence
Imaging in Low Anterior Resection.
Diseases of the colon and rectum.
2021;64(8):995-1002.
9. De Nardi P, Elmore U, Maggi G,
Maggiore R, Boni L, Cassinotti E,
et al. Intraoperative angiography
with indocyanine green to assess
anastomosis perfusion in patients
undergoing laparoscopic colorectal
resection: results of a multicenter
randomized controlled trial. Surgical
endoscopy. 2020;34(1):53-60.
10. Alekseev M, Rybakov E, Shelygin
Y, Chernyshov S, Zarodnyuk I. A
Study investigating the Perfusion
of Colorectal Anastomoses Using
FLuorescence AnGiography: results
of FLAG randomized trial. Colorectal
Disease. 2020;22.
11. Watanabe J, Takemasa I, Kotake
M, Noura S, Kimura K, Suwa H, et
al. Blood Perfusion Assessment by
Indocyanine Green Fluorescence
Imaging for Minimally Invasive Rectal
Cancer Surgery (EssentiAL trial): A
Randomized Clinical Trial. Annals of
surgery. 2023;278(4):e688-e94.
12. Armstrong G, Croft J, Corrigan N,
Brown JM, Goh V, Quirke P, et al.
IntAct: intra-operative fluorescence
angiography to prevent anastomotic
leak in rectal cancer surgery:
a randomized controlled trial.
Colorectal disease : the official journal
of the Association of Coloproctology
of Great Britain and Ireland.
2018;20(8):O226-o34.
13. Meijer R, Faber R, Bijlstra O, Braak J,
Kranenbarg E, Putter H, et al. AVOID;
a phase III, randomised controlled
trial using indocyanine green for the prevention of anastomotic leakage
in colorectal surgery. BMJ Open.
2022;12:e051144.
14. Jafari MD, Lee KH, Halabi WJ, Mills
SD, Carmichael JC, Stamos MJ, et
al. The use of indocyanine green
fluorescence to assess anastomotic
perfusion during robotic assisted
laparoscopic rectal surgery. Surgical
endoscopy. 2013;27(8):3003-8.
15. Blanco-Colino R, Espin-Basany
E. Intraoperative use of ICG
fluorescence imaging to reduce
the risk of anastomotic leakage in
colorectal surgery: a systematic
review and meta-analysis. Techniques
in coloproctology. 2018;22(1):15-23.
16. Shen R, Zhang Y, Wang T.
Indocyanine Green Fluorescence
Angiography and the Incidence of
Anastomotic Leak After Colorectal
Resection for Colorectal Cancer: A
Meta-analysis. Diseases of the colon
and rectum. 2018;61(10):1228-34.
17. Tsang YP, Leung LA, Lau CW, Tang
CN. Indocyanine green fluorescence
angiography to evaluate anastomotic
perfusion in colorectal surgery.
International journal of colorectal
disease. 2020;35(6):1133-9.
18. Wojcik M, Doussot A, Manfredelli
S, Duclos C, Paquette B, Turco C,
et al. Intra-operative fluorescence
angiography is reproducible and
reduces the rate of anastomotic
leak after colorectal resection for
cancer: a prospective case-matched
study. Colorectal disease : the
official journal of the Association of
Coloproctology of Great Britain and
Ireland. 2020;22(10):1263-70.
19. Jafari MD, Wexner SD, Martz
JE, McLemore EC, Margolin DA,
Sherwinter DA, et al. Perfusion
assessment in laparoscopic left-sided/
anterior resection (PILLAR II): a
multi-institutional study. Journal of
the American College of Surgeons.
2015;220(1):82-92.e1.
20. Qin Q, Ma T, Deng Y, Zheng J,
Zhou Z, Wang H, et al. Impact
of Preoperative Radiotherapy on
Anastomotic Leakage and Stenosis
After Rectal Cancer Resection:
Post Hoc Analysis of a Randomized
Controlled Trial. Diseases of the colon
and rectum. 2016;59(10):934-42.
21. Lucarini A, Guida AM, Orville
M, Panis Y. Indocyanine green
fluorescence angiography could
reduce the risk of anastomotic
leakage in rectal cancer surgery: a
systematic review and meta-analysis
of randomized controlled trials.
Colorectal disease : the official journal
of the Association of Coloproctology
of Great Britain and Ireland.
2024;26(3):408-16.

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