Objectives Reducing anastomotic leak rates after rectosigmoid resection and anastomosis is a priority in patients undergoing gynecologic oncology surgery. Therefore, we investigated the implications of performing near-infrared angiography (NIR) via proctoscopy to assess anastomotic perfusion at the time of rectosigmoid resection and anastomosis.

Methods We identified all patients who underwent rectosigmoid resection and anastomosis for a gynecologic malignancy between January 1, 2013 until December 31, 2018. NIR proctoscopy was assessed via the PinPoint Endoscopic Imaging System (NOVADAQ, Canada).

Results A total of 410 patients were identified, among which NIR was utilized in 134 (32.7%) patients. There were no statistically significant differences in age, race, BMI, type of malignancy or surgery, histology, FIGO stage, hypertension, diabetes, or pre-operative chemotherapy between NIR and non-NIR groups. All cases of rectosigmoid resection underwent stapled anastomosis. The anastomotic leak rate was 2/134 (1.2%) in the NIR cohort compared to 13/276 (4.7%) non-NIR (p=0.10). Diverting ostomy was performed in 9/134 (6.7%) NIR patients and 53/276 (19%) non-NIR patients (p<0.001). Post-operative abscesses occurred in 4/134 (6.0%) NIR patients and 44/276 (15.9%) non-NIR patients (p=0.004). The NIR cohort had significantly fewer post-operative interventional procedures (12/134, 9.0% NIR vs. 55/276, 20.0% non-NIR, p=0.01) and significantly fewer 30-day readmissions (15/134, 11.2% NIR vs. 60/276, 21.7% non-NIR, p=0.01).

Conclusions The use of NIR proctoscopy is a safe tool to assess anastomotic rectal perfusion after rectosigmoid resection and anastomosis with a low anastomotic leak rate of 1.2%. Its potential usefulness should be evaluated within randomized trials in patients undergoing gynecologic cancer surgery.