Indocyanine green fluorescence angiography during low anterior resection for low rectal cancer: results of a comparative cohort study

I. Mizrahi, M. Abu-Gazala, A. S. Rickles, L. M. Fernandez, A. Petrucci, J. Wolf, D. R. Sands, S. D. Wexner

Anastomotic leak (AL) after low anterior resection (LAR) is associated with increased morbidity, mortality, cost and cancer recurrence rates. The aim of this study was to evaluate the impact of fluorescence angiography (FA) on AL following LAR for low rectal cancer. This is a single surgeon retrospective cohort study with a historical, consecutively sampled case matched control group. The institution's prospectively maintained institutional review board (IRB)-approved database was queried for all patients who underwent a laparoscopic LAR for rectal neoplasia with a colorectal or coloanal anastomosis < 5 cm from the anal verge between 2013 and 2016. Patients were divided into two groups: patients in whom FA was employed (study group, 2015-2016) and those patients in whom it was not (control group, 2013-2015). All patients were diverted with a loop ileostomy. The primary outcome measured was the AL rate and the secondary outcome measured was change in surgical plan following FA. Sixty patients were included in the study: 30 patients in the FA group and 30 patients in the control group. Patients' demographics, the use of neoadjuvant chemoradiation, tumor stage, and mean height of anastomosis were comparable between the study groups. FA led to a change in surgical plan in four patients (13.3%) none of who suffered an AL. Two patients in the control group had a clinically and radiologically confirmed AL, whereas there were no leaks in the FA group (6.7% vs. 0%, p = 0.49). FA changed the surgical plan in 13.3% of LAR's, potentially reducing the incidence of AL in these high-risk patients.