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  • Anastomotic diversion rates following integration of indocyanine green fluorescence angiography in cytoreductive surgery for ovarian cancer

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Original research
Anastomotic diversion rates following integration of indocyanine green fluorescence angiography in cytoreductive surgery for ovarian cancer
  1. Lina Salman1,
  2. Liat Hogen2,
  3. Manjula Maganti3 and
  4. Taymaa May4,5
    1. 1 Department of Obstetrics and Gynecology, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
    2. 2 Department of Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
    3. 3 Department of Biostatistics, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
    4. 4 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
    5. 5 Division of Gynecologic Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
    1. Correspondence to Dr Taymaa May; tmay1{at}mgb.org

    Abstract

    Objective To compare rates of diverting ileostomy in patients with ovarian cancer, undergoing cytoreduction with bowel resection before and after the acquisition of indocyanine green fluorescence angiographic scans for anastomotic perfusion assessment.

    Methods A retrospective cohort study of patients with ovarian cancer undergoing bowel resection during cytoreductive surgery between 2010 and 2021. We evaluated whether using indocyanine green fluorescence angiography impacted rates of diverting ileostomy. Baseline characteristics and rates of diversion were compared between those who had indocyanine green fluorescence assessment and those with bowel resection without anastomotic fluorescence assessment.

    Results Overall, 181 patients were included. Of whom, 84 (46%) underwent anastomotic fluorescence assessment following bowel resection, and 97 (54%) had bowel resection without assessment. Mean age of the cohort was 58.2 years and 132 (73%) had stage III disease. There was no difference between groups in rates of diverting ileostomy (41% vs 41%, p=1.0). In a univariable logistic regression, the odds of having an ileostomy were 2.92 times higher in patients undergoing primary surgery than in patients undergoing interval cytoreductive surgery (95% CI 1.25 to 6.85, p=0.013). The use of fluorescence angiography did not predict performing diverting ileostomy (OR=0.97, 95% CI (0.53 to 1.76), p=0.92).

    Conclusion In this cohort, the simple introduction of indocyanine green fluorescence angiography had no impact on the rates of anastomotic diversion. Developing a systematic, reproducible diversion protocol with selection criteria that include fluorescence angiography is needed to assess the impact of this surgically innovative tool on the rates of anastomotic diversion in patients with advanced ovarian cancer.

    • Ovarian Cancer
    • Colorectal Surgery

    Data availability statement

    Data are available upon reasonable request. In accordance with the journal’s guidelines, we will provide our data for independent analysis by a selected team by the Editorial Team, for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.

    https://doi.org/10.1136/ijgc-2024-005753

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      Data availability statement

      Data are available upon reasonable request. In accordance with the journal’s guidelines, we will provide our data for independent analysis by a selected team by the Editorial Team, for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.

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      Footnotes

      • Presented at The manuscript was presented as an oral featured poster at the IGCS annual global meeting, New York City, USA, 2022.

      • Contributors LS: conceptualization; methodology; visualization; writing - original draft preparation; writing - review and editing; LH: visualization; writing - review and editing; MM: formal analysis; writing - review and editing; TM: conceptualization; methodology; visualization; supervision; writing - review and editing; guarantor.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.