Introduction/Background Different studies have previously demonstrated the efficacy of intravenous indocyanine green (ICG) to assess the perfusion of bowel and urinary anastomoses. Nevertheless, the evidence of the use of ICG to assess anastomoses perfusion in patients with gynecological cancer undergoing pelvic exenteration (after radiotherapy) is scanty. The aim of the present study was to assess whether the level of ICG perfusion of ileal conduit urinary diversion (UD) could predict anastomosis leak and/or benign ureteric stenosis.
Methodology Prospective, observational, single-center study including consecutive patients undergoing anterior/total pelvic exenteration due to persistent/recurrent gynecologic cancers between 08/2020 and 02/2023. All patients underwent intravenous injection of 3–5ml of ICG (5mg/ml) once the UD was completed. A near-infrared camera was used to evaluate ICG perfusion of anastomoses (ileum–ileum, right and left ureter with small bowel, and colostomy or colorectal sides of anastomosis) a few seconds after ICG injection. Degree of perfusion was intraoperatively assessed independently by one urologist and one gynecologic oncologist and was divided according to a four-tier classification (---/+--/++-/+++).
Results Fifty-six patients were included. Patients’ characteristics are showed in table 1. Vascularization was considered optimal (+++) in right ureter in 29 (51.8%) and in left ureter in 22 (39.3%) patients. Optimal right ureter perfusion was associated with risk reduction of >G2 right hydronephrosis (OR: 8.05, 95%CI: 1.95–33.08; p=0.004); no association between left ureter perfusion and risk of >G2 left hydronephrosis was noted (OR: 1.87, 95%CI:0.51–6.95; p=0.347). 29 (51.8%) patients had good (++-/+++) bilateral ureter perfusion and none of them experienced ileal conduit anastomotic leak. All three (5.3%) patients undergoing UD anastomosis leak had a poor (+--/---) ICG perfusion.
Conclusion The use of ICG to assess perfusion of UD anastomoses was a useful tool to predict benign ureteric stenosis and UD leak. Patients with poor ICG perfusion could benefit from intra-operative actions and more intense post-operative surveillance.
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