Invited Commentary <\/p>\n\n\n\n
March 5, 2025<\/p>\n\n\n\n
Anastomotic leaks (ALs) are often devastating complications that frequently require unplanned reoperation, creation of a stoma that may be permanent, and months of management until the potential restoration of gut continuity.1<\/a><\/sup> Fluorescence imaging (FI) using indocyanine green (ICG) offers an intraoperative assessment of perfusion that is ostensibly more objective than a surgeon\u2019s gross assessment of nutrient arterial blood flow. The authors of the ICG-COLORAL2<\/a><\/sup> study point out that prior evaluations3<\/a><\/sup>-5<\/a><\/sup> of ICG-FI include few prospective studies; focused primarily on higher-risk colorectal anastomoses, these studies provide mixed results regarding the benefit of ICG-FI in lowering AL rates.<\/a><\/p>\n\n\n\n The ICG-CORAL sought to evaluate whether ICG-FI would lower AL rates among patients undergoing elective laparoscopic colon resections; the authors ensured a low baseline risk of AL by excluding patients with inflammatory bowel disease and those with an anastomosis distal to the anterior peritoneal reflection. The key findings of this study include that AL rates were comparable between the ICG-FI cohort and those where the surgeon used their best judgment to assess bowel perfusion with a possible benefit for ICG-FI in left-sided resections based on an as-treated analysis, though this finding from a subgroup analysis is of uncertain reliability. No association between either time to maximal ICG signal intensity or signal intensity was predictive of AL. This latter observation suggests that the study outcomes were unlikely to be affected by interoperator variability with how ICG-FI was being performed or interpreted. This all suggests generalizable results for patients undergoing colon resections under the most favorable circumstances and lowest baseline risk.<\/a><\/p>\n\n\n\n The development of AL following lower risk, even straightforward colon resections, and the observation that AL can be severe regardless of the simplicity of the index surgery has spurred interest in the routine use of ICG-FI. FI is simple to use, and arguably to interpret, while not being particularly expensive to use. The best available randomized trial data provide mixed results for FI lowering AL. Perhaps one of the challenges with assessing FI in this regard stems from the frequent uncertainty as to why patients develop leaks in the first place; there are immunocompetent patients with tension-free anastomoses involving grossly normal intestine who develop AL, and treating surgeons are rarely able to identify a specific cause. ALs are likely multifactorial, with intraoperative perfusion being but one factor, one that may not predict perfusion status at a later time point. FI may be best used in a manner similar to how surgeons perform leak tests for anastomoses, where the test assures the surgeon that prior to leaving the operating room there is no correctable deficiency involving the anastomosis but with a favorable test not necessarily guaranteeing normal anastomotic healing at a later date.<\/p>\n","protected":false},"excerpt":{"rendered":" Invited Commentary March 5, 2025 Indocy […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[24,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27955"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=27955"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27955\/revisions"}],"predecessor-version":[{"id":27956,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27955\/revisions\/27956"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=27955"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=27955"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=27955"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}