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26 The impact of using near-infrared angiography during rectosigmoid resection and anastampsis in patients undergoing gynecologic cancer surgery
  1. L Moukarzel1,
  2. S Leiva2,
  3. M Wu1,
  4. M Byrne3,
  5. N Abu-Rustum1,
  6. Y Sonoda1,
  7. G Gardner1,
  8. M Leitao1,
  9. V Broach1,
  10. D Chi1,
  11. K Long Roche1 and
  12. O Zivanovic1
  1. 1Memorial Sloan Kettering Cancer Center, Gynecology Service Department of Surgery, New York, USA
  2. 2Hurley Medical Center, Obstetrics and Gynecology, Flint, USA
  3. 3Hospital of the University of Pennsylvania, Obstetrics and Gynecology, Philadelphia, USA


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.

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