Andrea Spota1,2, Mahdi Al-Taher3, Eric Felli3, Salvador Morales Conde4,5, Ivano Dal Dosso6, Gianluigi Moretto7, Giuseppe Spinoglio8, Gianluca Baiocchi9, Ramon Vilallonga10, Harmony Impellizzeri7, Gonzalo P Martin-Martin11, Lorenzo Casali12, Christian Franzini12, Marta Silvestri13, Nicolò de Manzini13, Maurizio Castagnola14, Marco Filauro14, Davide Cosola13, Catalin Copaescu15, Giovanni Maria Garbarino16, Antonio Pesce17, Marcello Calabrò18, Paola de Nardi19, Gabriele Anania20, Thomas Carus21, Luigi Boni22, Alessandro Patané23, Caterina Santi12, Alend Saadi24, Alessio Rollo12, Roland Chautems24, José Noguera25, Jan Grosek26, Giancarlo D'Ambrosio27, Carlos Marques Ferreira28, Gregor Norcic26, Giuseppe Navarra29, Pietro Riva30, Silvia Quaresima27, Alessandro Paganini27, Nunzio Rosso31, Paolo De Paolis32, Andrea Balla27, Marc Olivier Sauvain24, Eleftherios Gialamas24, Giorgio Bianchi12, Gaetano La Greca33, Carlo Castoro30, Andrea Picchetto27, Alessandro Franchello32, Luciano Tartamella12, Robert Juvan26, Orestis Ioannidis34, Jurij Ales Kosir26, Emilio Bertani35, Laurents Stassen36, Jacques Marescaux1, Michele Diana37,38,39,40. 1. IRCAD Research Institute Against Digestive Cancer, Strasbourg, France. 2. Scuola di Specializzazione in Chirurgia Generale, Università Degli Studi di Milano, Milano, Italy. 3. IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France. 4. Unit of Innovation in Minimally Invasive Surgery, Department of General Surgery, University Hospital Virgen del Rocío, University of Sevilla, Sevilla, Spain. 5. General and Digestive Unit, Hospital Quironsalud Sagrado Corazon, Sevilla, Spain. 6. Ospedale Fracastoro, Verona, Italy. 7. Ospedale Pederzoli, Peschiera del Garda, Italy. 8. Candiolo Cancer Institute IRCCS, Candiolo, Italy. 9. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. 10. Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain. 11. Hospital Universitario Son Espases, Palma, Spain. 12. Ospedale di Vaio, Fidenza, Italy. 13. Clinica Chirurgica, University of Trieste, Trieste, Italy. 14. Ospedali Galliera, Genoa, Italy. 15. Ponderas Academic Hospital, Bucharest, Romania. 16. San Pietro Fatebenefratelli Hospital, Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Roma, Italy. 17. GF Ingrassia, Catania, Italy. 18. Agnelli Hospital, Pinerolo, Italy. 19. IRCCS San Raffaele Scientific Institute, Milan, Italy. 20. Az. Ospedaliera Universitaria, Ferrara, Italy. 21. Elisabeth-Hospital, Thuine, Germany. 22. Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico di Milano, University of Milan, Milano, Italy. 23. Santa Maria degli Angeli, Pordenone, Italy. 24. Réseau Hospitalier Neuchâtelois, Neuchatel, Switzerland. 25. CHUAC, A Coruña, Galicia, Spain. 26. University Medical Centre Ljubljana, Ljubljana, Slovenia. 27. Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. 28. Hospital de Santa Maria, Lisbon, Portugal. 29. Ospedale Martino, Messina, Italy. 30. Unit of Foregut Surgery, IRCCS Humanitas Clinical and Research Center, Rozzano, Milano, Italy. 31. Chirurgia Generale, Ragusa, Italy. 32. , Chirurgia 4 Le Molinette, Turin, Italy. 33. Ospedale Cannizzaro, Catania, Italy. 34. General Hospital Papanikolaou, Thessaloniki, Greece. 35. IEO, Milan, Italy. 36. Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. 37. IRCAD Research Institute Against Digestive Cancer, Strasbourg, France. michele.diana@ircad.fr. 38. IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France. michele.diana@ircad.fr. 39. Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France. michele.diana@ircad.fr. 40. ICube Lab, Photonics for Health, University of Strasbourg, Strasbourg, France. michele.diana@ircad.fr.
Abstract
BACKGROUND: Anastomotic leakage (AL) is one of the dreaded complications following surgery in the digestive tract. Near-infrared fluorescence (NIRF) imaging is a means to intraoperatively visualize anastomotic perfusion, facilitating fluorescence image-guided surgery (FIGS) with the purpose to reduce the incidence of AL. The aim of this study was to analyze the current practices and results of NIRF imaging of the anastomosis in digestive tract surgery through the EURO-FIGS registry. METHODS: Analysis of data prospectively collected by the registry members provided patient and procedural data along with the ICG dose, timing, and consequences of NIRF imaging. Among the included upper-GI, colorectal, and bariatric surgeries, subgroup analysis was performed to identify risk factors associated with complications. RESULTS: A total of 1240 patients were included in the study. The included patients, 74.8% of whom were operated on for cancer, originated from 8 European countries and 30 hospitals. A total of 54 surgeons performed the procedures. In 83.8% of cases, a pre-anastomotic ICG dose was administered, and in 60.1% of cases, a post-anastomotic ICG dose was administered. A significant difference (p < 0.001) was found in the ICG dose given in the four pathology groups registered (range: 0.013-0.89 mg/kg) and a significant (p < 0.001) negative correlation was found between the ICG dose and BMI. In 27.3% of the procedures, the choice of the anastomotic level was guided by means of NIRF imaging which means that in these cases NIRF imaging changed the level of anastomosis which was first decided based on visual findings in conventional white light imaging. In 98.7% of the procedures, the use of ICG partly or strongly provided a sense of confidence about the anastomosis. A total of 133 complications occurred, without any statistical significance in the incidence of complications in the anastomoses, whether they were ICG-guided or not. CONCLUSION: The EURO-FIGS registry provides an insight into the current clinical practice across Europe with respect to NIRF imaging of anastomotic perfusion during digestive tract surgery.
BACKGROUND: Anastomotic leakage (AL) is one of the dreaded complications following surgery in the digestive tract. Near-infrared fluorescence (NIRF) imaging is a means to intraoperatively visualize anastomotic perfusion, facilitating fluorescence image-guided surgery (FIGS) with the purpose to reduce the incidence of AL. The aim of this study was to analyze the current practices and results of NIRF imaging of the anastomosis in digestive tract surgery through the EURO-FIGS registry. METHODS: Analysis of data prospectively collected by the registry members provided patient and procedural data along with the ICG dose, timing, and consequences of NIRF imaging. Among the included upper-GI, colorectal, and bariatric surgeries, subgroup analysis was performed to identify risk factors associated with complications. RESULTS: A total of 1240 patients were included in the study. The included patients, 74.8% of whom were operated on for cancer, originated from 8 European countries and 30 hospitals. A total of 54 surgeons performed the procedures. In 83.8% of cases, a pre-anastomotic ICG dose was administered, and in 60.1% of cases, a post-anastomotic ICG dose was administered. A significant difference (p < 0.001) was found in the ICG dose given in the four pathology groups registered (range: 0.013-0.89 mg/kg) and a significant (p < 0.001) negative correlation was found between the ICG dose and BMI. In 27.3% of the procedures, the choice of the anastomotic level was guided by means of NIRF imaging which means that in these cases NIRF imaging changed the level of anastomosis which was first decided based on visual findings in conventional white light imaging. In 98.7% of the procedures, the use of ICG partly or strongly provided a sense of confidence about the anastomosis. A total of 133 complications occurred, without any statistical significance in the incidence of complications in the anastomoses, whether they were ICG-guided or not. CONCLUSION: The EURO-FIGS registry provides an insight into the current clinical practice across Europe with respect to NIRF imaging of anastomotic perfusion during digestive tract surgery.
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