ICG fluorescence angiography reduces anastomotic leakage after laparoscopic surgery for malignant rectal tumors: a propensity score-matched study
Abstract
Background
Colorectal cancer (CRC) is a leading cause of cancer-related mortality globally, with anastomotic leakage (AL) representing a severe complication after colorectal surgery. Intraoperative indocyanine green fluorescence angiography (ICG-FI) has shown potential in improving tissue perfusion assessment and may reduce AL risk. However, its effectiveness in laparoscopic low anterior resection (LAR) for rectal cancer requires further investigation using rigorous cohort designs.
Aim
To evaluate the effectiveness of intraoperative ICG-FI in reducing symptomatic AL and improving surgical outcomes in patients undergoing LAR for rectal cancer using a propensity score-matched cohort design.
Methods
This retrospective single-center study conducted at Shandong Linglong Yingcheng Hospital (September 2017-September 2024) analyzed 854 patients who underwent laparoscopic LAR for rectal cancer. Of these, 507 received ICG-FI and 347 served as controls. Propensity score matching balanced key variables. Primary endpoint was symptomatic AL incidence within 30 days postoperatively. Secondary endpoints included operative duration, blood loss, reoperation rates, and hospital stay.
Results
After matching, 302 patients were included in each group. Symptomatic AL incidence was significantly lower in the ICG-FI group (5.6% vs. 11.9%, p=0.006). Severe AL (Clavien-Dindo grade ≥III) and 30-day reoperation rates were also reduced in the ICG-FI group (both 1.3% vs. 4.0%, p=0.043). Patients in the ICG-FI group resumed dietary intake significantly earlier. No adverse events related to ICG injection occurred, with adequate vascular perfusion in 90.7% of cases.
Conclusion
Intraoperative ICG-FI significantly reduces AL incidence and reoperation rates in laparoscopic LAR for rectal cancer. These findings support ICG-FI as an effective tool for optimizing tissue perfusion assessment and improving surgical outcomes. Further research should refine ICG-FI protocols and explore broader clinical applications.