RT Journal Article
SR Electronic
T1 26 The impact of using near-infrared angiography during rectosigmoid resection and anastampsis in patients undergoing gynecologic cancer surgery
JF International Journal of Gynecologic Cancer
JO Int J Gynecol Cancer
FD BMJ Publishing Group Ltd
SP A16
OP A16
DO 10.1136/ijgc-2019-IGCS.26
VO 29
IS Suppl 3
A1 Moukarzel, L
A1 Leiva, S
A1 Wu, M
A1 Byrne, M
A1 Abu-Rustum, N
A1 Sonoda, Y
A1 Gardner, G
A1 Leitao, M
A1 Broach, V
A1 Chi, D
A1 Long Roche, K
A1 Zivanovic, O
YR 2019
UL http://ijgc.bmj.com/content/29/Suppl_3/A16.1.abstract
AB 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.