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Minerva Chirurgica 2018 Feb 21

DOI: 10.23736/S0026-4733.18.07632-0


lingua: Inglese

How to reduce surgical complications in rectal cancer surgery using fluorescence techniques

Elisa CASSINOTTI 1 , Stefano COSTA 1, Stefano DE PASCALE 2, Barbara OREGGIA 1, Giorgio PALAZZINI 3, Luigi BONI 1

1 Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy; 2 Chirurgia Generale 2, ASST Spedali Civili, Brescia, Italy; 3 Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy


BACKGROUND: Anastomotic leakage (AL) is a serious complication in colorectal surgery leading to significant morbidity and mortality. Progressively lower anastomoses are associated with a greater leak rate. Adequate bowel perfusion has been stressed as one of the key elements for suture healing. Currently, there is no widespread method to assess and quantify the perfusion of gastrointestinal anastomoses intraoperatively, besides the subjective evaluation by the surgeon. The aim of this paper is to describe the basis of Indocyanine Green (ICG) fluorescence guided surgery applied to assessment of bowel perfusion and to highlight studies on the use of fluorescence angiography (FA) in laparoscopic rectal surgery.
METHODS: ICG fluorescence guided surgery has increasingly been used as a tool for intraoperative diagnostics to assess microperfusion and viability of tissues by means of a real-time fluorescence angiography (FA); this technique has achieved the role of major contribution to intraoperative decision making during surgical procedures, especially in order to assess bowel perfusion before anastomosis creation in colorectal surgery.
RESULTS: Several studies in literature already reported that ICG FA as a feasible technique to decrease AL rate in colorectal surgery; to date no randomised controlled trials have been completed but large series and prospective studies that focus on fluorescence perfusion assessment in rectal surgery have been published.
CONCLUSIONS: Real time intraoperative ICG fluorescent angiography (FA) is a safe and feasible technique to guide the surgeon in intraoperative decision-making process. ICG FA seems to reduce AL rates following rectal surgery for cancer. However large well-designed RCTs are needed to provide evidence for its routine use.

KEY WORDS: Rectal cancer - Fluorescence - Anastomotic leakage - Indocyanine green

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Publication History

Article first published online: February 21, 2018
Manuscript accepted: February 9, 2018
Manuscript received: January 11, 2018

Per citare questo articolo

Cassinotti E, Costa S, De Pascale S, Oreggia B, Palazzini G, Boni L. How to reduce surgical complications in rectal cancer surgery using fluorescence techniques. Minerva Chir 2018 Feb 21. DOI: 10.23736/S0026-4733.18.07632-0

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