Prospective evaluation of indocyanine green fluorescence for anastomotic site selection in laparoscopic colorectal cancer surgery.

Background

Indocyanine Green (ICG) fluorescence imaging has emerged as a valuable tool for intraoperative assessment of bowel perfusion in colorectal surgery, with the potential to reduce anastomotic leakage. However, standardized protocols for its use remain undefined. This study aimed to evaluate the feasibility and clinical impact of ICG fluorescence imaging in laparoscopic colorectal resections.

Methods

A prospective cohort of 60 patients undergoing laparoscopic sigmoidectomy or low anterior resection for colorectal cancer was analyzed. ICG was administered after high vascular ligation to guide anastomotic site selection. Perfusion was assessed using ICG fluorescence and the marginal arcade test. Primary outcomes were changes in anastomotic site and leakage rates; secondary outcomes included fluorescence time and its association with clinical variables.

Results

The mean time to fluorescence appearance was 24.5 seconds (range 8-45), with no significant differences according to sex (p = 0.20), age (p = 0.24), or neoadjuvant therapy (p = 0.38). ICG imaging led to modification of the planned anastomotic site in 6.7% of cases (n = 4), none of which developed leakage. In two cases, discordance between ICG fluorescence and marginal arcade assessment was observed. Overall, anastomotic leakage occurred in 6.7% (n = 4), exclusively in patients who had received neoadjuvant radiotherapy (p = 0.04). No association was found between leakage and anastomotic height, fluorescence time, or marginal arcade findings. No adverse reactions to ICG were reported.

Conclusion

ICG fluorescence imaging is a safe and feasible adjunct for intraoperative perfusion assessment that supports anastomotic site selection and may contribute to reducing anastomotic leakage. Further studies incorporating quantitative fluorescence metrics are warranted.