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  • 2022-RA-1295-ESGO The role of intraoperative indocyanine green fluorescence angiography in preventing anastomotic leakage after colorectal resection for advanced ovarian cancer

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Ovarian cancer
2022-RA-1295-ESGO The role of intraoperative indocyanine green fluorescence angiography in preventing anastomotic leakage after colorectal resection for advanced ovarian cancer
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  1. Gabriella Schivardi1,2,
  2. Ana Ciobanu2,
  3. Andrea Dell’Acqua3,
  4. Luigi de Vitis2,
  5. Giulio Bonaldo2,
  6. Ilaria Betella2,
  7. Maria Teresa Achilarre2,
  8. Alessia Aloisi2,
  9. Annalisa Garbi2,
  10. Andrea Mariani1,
  11. Nicoletta Colombo2,4,
  12. Vanna Zanagnolo2,
  13. Angelo Maggioni2,
  14. Roberto Biffi5,
  15. Francesco Multinu2 and
  16. Giovanni Damiano Aletti2,6
  1. 1Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN
  2. 2Department of Gynecology, European Institute of Oncology, IEO, IRCCS, Milan, Italy
  3. 3Gynaecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
  4. 4Faculty of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
  5. 5Department of Abdomino-pelvic Surgery, European Institute of Oncology, IEO, IRCCS, Milan, Italy
  6. 6Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

Abstract

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.

View this table:
Abstract 2022-RA-1295-ESGO Table 1

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.

https://doi.org/10.1136/ijgc-2022-ESGO.681

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