Alberto Arezzo1, Marco Augusto Bonino2, Frédéric Ris2, Luigi Boni3, Elisa Cassinotti3, Dominic Chi Chung Foo4, Nga Fan Shum4, Alberto Brolese5, Francesco Ciarleglio5, Deborah S Keller6, Riccardo Rosati7, Paola De Nardi7, Ugo Elmore7, Uberto Fumagalli Romario8, Mehraneh Dorna Jafari9, Alessio Pigazzi9, Evgeny Rybakov10, Mikhail Alekseev10, Jun Watanabe11, Nereo Vettoretto12, Roberto Cirocchi13, Roberto Passera14, Edoardo Forcignanò15, Mario Morino15. 1. Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy. alberto.arezzo@unito.it. 2. Department of Surgery, Service of Visceral Surgery, Geneva University Hospitals and medical school, Geneva, Switzerland. 3. Department of Surgery, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy. 4. Queen Mary Hospital, The University of Hong Kong, Hong Kong, China. 5. General Surgery II, Santa Chiara Hospital, Trento, Italy. 6. Department of Surgery, New York Presbyterian Hospital, Columbia University Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA. 7. Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy. 8. Digestive Surgery - European Institute of Oncology - IRCCS, Milan, Italy. 9. Colon and Rectal Surgery, General Surgery, UC Irvine Medical Center, Orange, CA, USA. 10. Surgical Department of Oncoproctology - State Scientific Centre of Coloproctology, Moscow, Russian Federation. 11. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan. 12. General Surgery, Montichiari Hospital, ASST Spedali Civili Brescia, Brescia, Italy. 13. Department of General Surgery and Surgical Oncology, Hospital of Terni, University of Perugia, Terni, Italy. 14. Department of Medical Sciences, University of Torino, Torino, Italy. 15. Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy.
Abstract
BACKGROUND: Fluorescence imaging by means of Indocyanine green (ICG) has been applied to intraoperatively determine the perfusion of the anastomosis. The purpose of this Individual Participant Database meta-analysis was to assess the effectiveness in decreasing the incidence of anastomotic leak (AL) after rectal cancer surgery. METHODS: We searched PubMed, Embase, Cochrane Library and ClinicalTrial.gov, EU Clinical Trials and ISRCTN registries on September 1st, 2019. We considered eligible those studies comparing the assessment of anastomotic perfusion during rectal cancer surgery by intraoperative use of ICG fluorescence compared with standard practice. We defined as primary outcome the incidence of AL at 30 days after surgery. The studies were assessed for quality by means of the ROBINS-I and the Cochrane risk tools. We calculated odds ratios (ORs) using the Individual patient data analysis, restricted to rectal lesions, according to original treatment allocation. RESULTS: The review of the literature and international registries produced 15 published studies and 5 ongoing trials, for 9 of which the authors accepted to share individual participant data. 314 patients from two randomized trials, 452 from three prospective series and 564 from 4 non-randomized studies were included. Fluorescence imaging significantly reduced the incidence of AL (OR 0.341; 95% CI 0.220-0.530; p < 0.001), independent of age, gender, BMI, tumour and anastomotic distance from the anal verge and neoadjuvant therapy. Also, overall morbidity and reintervention rate were positively influenced by the use of ICG. CONCLUSIONS: The incidence of AL may be reduced when ICG fluorescence imaging is used to assess the perfusion of a colorectal anastomosis. Limitations relate to the consistent number of non-randomized studies included and their heterogeneity in defining and assessing AL. Ongoing large randomized studies will help to determine the exact role of routine ICG fluorescence imaging may decrease the incidence of AL in surgery for rectal cancer.
BACKGROUND: Fluorescence imaging by means of Indocyanine green (ICG) has been applied to intraoperatively determine the perfusion of the anastomosis. The purpose of this Individual Participant Database meta-analysis was to assess the effectiveness in decreasing the incidence of anastomotic leak (AL) after rectal cancer surgery. METHODS: We searched PubMed, Embase, Cochrane Library and ClinicalTrial.gov, EU Clinical Trials and ISRCTN registries on September 1st, 2019. We considered eligible those studies comparing the assessment of anastomotic perfusion during rectal cancer surgery by intraoperative use of ICG fluorescence compared with standard practice. We defined as primary outcome the incidence of AL at 30 days after surgery. The studies were assessed for quality by means of the ROBINS-I and the Cochrane risk tools. We calculated odds ratios (ORs) using the Individual patient data analysis, restricted to rectal lesions, according to original treatment allocation. RESULTS: The review of the literature and international registries produced 15 published studies and 5 ongoing trials, for 9 of which the authors accepted to share individual participant data. 314 patients from two randomized trials, 452 from three prospective series and 564 from 4 non-randomized studies were included. Fluorescence imaging significantly reduced the incidence of AL (OR 0.341; 95% CI 0.220-0.530; p < 0.001), independent of age, gender, BMI, tumour and anastomotic distance from the anal verge and neoadjuvant therapy. Also, overall morbidity and reintervention rate were positively influenced by the use of ICG. CONCLUSIONS: The incidence of AL may be reduced when ICG fluorescence imaging is used to assess the perfusion of a colorectal anastomosis. Limitations relate to the consistent number of non-randomized studies included and their heterogeneity in defining and assessing AL. Ongoing large randomized studies will help to determine the exact role of routine ICG fluorescence imaging may decrease the incidence of AL in surgery for rectal cancer.
Authors: Kamil Safiejko; Radoslaw Tarkowski; Tomasz Piotr Kozlowski; Maciej Koselak; Marcin Jachimiuk; Aleksander Tarasik; Michal Pruc; Jacek Smereka; Lukasz Szarpak Journal: Cancers (Basel) Date: 2022-02-18 Impact factor: 6.639
Authors: Thinzar M Lwin; Michael A Turner; Siamak Amirfakhri; Hiroto Nishino; Robert M Hoffman; Michael Bouvet Journal: Cells Date: 2022-01-12 Impact factor: 6.600