Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 22;15(23):5528.
doi: 10.3390/cancers15235528.

NIR ICG-Enhanced Fluorescence: A Quantitative Evaluation of Bowel Microperfusion and Its Relation to Central Perfusion in Colorectal Surgery

Norma Depalma  1 , Stefano D'Ugo  1 , Farshad Manoochehri  1 , Annarita Libia  1 , William Sergi  1 , Tiziana R L Marchese  1 , Stefania Forciniti  2 , Loretta L Del Mercato  2 , Prisco Piscitelli  3 , Stefano Garritano  1 , Fabio Castellana  4 , Roberta Zupo  4 , Marcello Giuseppe Spampinato  1
Affiliations

NIR ICG-Enhanced Fluorescence: A Quantitative Evaluation of Bowel Microperfusion and Its Relation to Central Perfusion in Colorectal Surgery

Norma Depalma et al. Cancers (Basel). .

Abstract

Background: To date, no standardized protocols nor a quantitative assessment of the near-infrared fluorescence angiography with indocyanine green (NIR-ICG) are available. The aim of this study was to evaluate the timing of fluorescence as a reproducible parameter and its efficacy in predicting anastomotic leakage (AL) in colorectal surgery.

Methods: A consecutive cohort of 108 patients undergoing minimally invasive elective procedures for colorectal cancer was prospectively enrolled. The difference between macro and microperfusion (ΔT) was obtained by calculating the timing of fluorescence at the level of iliac artery division and colonic wall, respectively.

Results: Subjects with a ΔT ≥ 15.5± 0.5 s had a higher tendency to develop an AL (p < 0.01). The ΔT/heart rate interaction was found to predict AL with an odds ratio of 1.02 (p < 0.01); a cut-off threshold of 832 was identified (sensitivity 0.86, specificity 0.77). Perfusion parameters were also associated with a faster bowel motility resumption and a reduced length of hospital stay.

Conclusions: The analysis of the timing of fluorescence provides a quantitative, easy evaluation of tissue perfusion. A ΔT/HR interaction ≥832 may be used as a real-time parameter to guide surgical decision making in colorectal surgery.

Keywords: NIR-ICG-enhanced fluorescence; anastomotic leakage; colorectal cancer; minimally invasive colorectal surgery.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Intraoperative ICG-NIR-enhanced fluorescence; (a) Fluorescence at the left common iliac artery, Ti; (b) fluorescence at the colic wall, Tw.
Figure 2
Figure 2
Study design.
Figure 3
Figure 3
Scatter plot of time ratio and delta time/heart rate interaction on curve estimation regression analysis (N: 108). The cut-off value of 832 is indicated by a red dotted line. The sample size distribution is indicated with a gray dotted line. Patients with complications were marked with triangular shapes.
Figure 4
Figure 4
Pearson’s correlation plot.
See this image and copyright information in PMC

References

    1. Vonlanthen R., Slankamenac K., Breitenstein S., Puhan M.A., Muller M.K., Hahnloser D., Hauri D., Graf R., Clavien P.-A. The impact of complications on costs of major surgical procedures: A cost analysis of 1200 patients. Ann. Surg. 2011;254:907–913. doi: 10.1097/SLA.0b013e31821d4a43. - DOI - PubMed
    1. McDermott F.D., Heeney A., Kelly M.E., Steele R.J., Carlson G.L., Winter D.C. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br. J. Surg. 2015;102:462–479. doi: 10.1002/bjs.9697. - DOI - PubMed
    1. Ashraf S.Q., Burns E.M., Jani A., Altman S., Young J.D., Cunningham C., Faiz O., Mortensen N.J. The economic impact of anastomotic leakage after anterior resections in English NHS hospitals: Are we adequately remunerating them? Color. Dis. 2013;15:e190–e198. doi: 10.1111/codi.12125. - DOI - PubMed
    1. Buchs N.C., Gervaz P., Secic M., Bucher P., Mugnier-Konrad B., Morel P. Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: A prospective monocentric study. Int. J. Color. Dis. 2007;23:265–270. doi: 10.1007/s00384-007-0399-3. - DOI - PubMed
    1. Mirnezami A., Mirnezami R., Chandrakumaran K., Sasapu K., Sagar P., Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: Systematic review and meta-analysis. Ann. Surg. 2011;253:890–899. doi: 10.1097/SLA.0b013e3182128929. - DOI - PubMed

LinkOut - more resources