Introduction/Background The use of intraoperative indocyanine green fluorescence angiography (ICG-FA) in the assessment of anastomotic perfusion after bowel resection has been widely increased in the last years. However, few data are available on its use for ovarian cancer surgery. This study aimed to assess the impact of ICG-FA in reducing anastomotic leakage after colorectal resection during primary cytoreductive surgery for advanced ovarian cancer (AOC).
Methodology Patients with AOC who underwent a primary cytoreductive surgery with colorectal resection at the European Institute of Oncology, Milan from 1/2009 to 12/2021 were retrospectively identified. The use of ICG-FA to assess the anastomotic perfusion was introduced at our institution on 1/2020. The rate of anastomotic leak after colorectal resection was compared between the group using ICG-FA and the group not using ICG-FA. The association between the use of ICG-FA and the occurrence of anastomotic leakage was evaluated with univariate and multivariate statistical analysis.
Results In total, 439 patients meeting inclusion criteria were included. Among them, in 118 (36.8%) the ICG-FA was used, while in 321 (63.2%) the ICG-FA was not used. Overall, 27/439 (6.1%) patients had an anastomotic leak, including 2/118 (1.69%) in the group using ICG-FA and 25/321 (7.8%) in the group not using ICG-FA. On univariate analysis, the presence of residual tumour (p=0.03) and surgical time(p=0.005) were predictors of colorectal anastomotic leakage, while the use of ICG-FA was a protective factor (p=0.02). On multivariate analysis, surgical time (p=0.02) was an independent predictor of colorectal anastomotic leakage, while the use of ICG-FA showed an independent protective role (p=0.01).
Conclusion The use of ICG-FA for the assessment of colorectal anastomosis perfusion has proven to be a safe and effective technique, showing a significant reduction in the rate of anastomotic leakage. This technique should be performed in all cases of ovarian cancer undergoing rectosigmoid resection.
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