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Research ArticleClinical Studies

The Role of Indocyanine Green in Laparoscopic Low Anterior Resections for Rectal Cancer Previously Treated With Chemo-radiotherapy: A Single-center Retrospective Analysis

ANTONIO BRESCIA, EDOARDO MARIA MUTTILLO, ILARIA ANGELICONE, ISABELLA MADAFFARI, FEDERICO MAGGI, ISABELLA SPERDUTI, MARCELLO GASPARRINI and MATTIA FALCHETTO OSTI
Anticancer Research January 2022, 42 (1) 211-216; DOI: https://doi.org/10.21873/anticanres.15475
ANTONIO BRESCIA
1Colon Rectal Surgery Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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EDOARDO MARIA MUTTILLO
1Colon Rectal Surgery Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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  • For correspondence: edoardomaria.muttillo@uniroma1.it
ILARIA ANGELICONE
2Radiotherapy Department, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
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ISABELLA MADAFFARI
1Colon Rectal Surgery Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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FEDERICO MAGGI
1Colon Rectal Surgery Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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ISABELLA SPERDUTI
3Unit of Biostatistical, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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MARCELLO GASPARRINI
1Colon Rectal Surgery Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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MATTIA FALCHETTO OSTI
2Radiotherapy Department, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Abstract

Aim: Anastomotic leakage represents the most fearful complication in colorectal surgery. Important risk factors for leakage are low anastomoses and preoperative radiotherapy. Many surgeons often unnecessarily perform a protective ileostomy, increasing costs and necessitating a second operation for recanalization. The aim of this study was to evaluate the role of indocyanine green in assessing bowel perfusion, even in cases of a low anastomosis on tissue treated with radiotherapy. Patients and Methods: Two groups of patients were selected: Group A (risky group) with only low extraperitoneal rectal tumors (<8 cm) previously treated with neoadjuvant chemo-radiotherapy; group B (no risk group) with only intraperitoneal rectal tumors (>8 cm), not previously treated with neoadjuvant therapy. Clinical postoperative outcome, morbidity, mortality and anastomotic leakage were compared between these two groups. Results: In group A, comprised of 35 patients, the overall complication rate was 8.6%, with two patients developing anastomotic leakage (5.7%). In group B, comprised of 53 patients, the overall complication rate was 17% with four cases with anastomotic leakage (7.5%). No statistical difference was observed for conversion rate, general complications, or anastomotic leakage. No statistical differences were observed in clinical variables except for American Society of Anesthesiologist score (p=0.04). Patients who developed complications during radiotherapy had no significant differences in postoperative outcomes compared with other patients. Conclusion: Indocyanine green appears to be safe and effective in assessing the perfusion of colorectal anastomoses, even in the highest-risk cases, potentially reducing the rate of ileostomy. The main limitation remains the lack of a universally replicable standard assessment.

Key Words:
  • Rectal cancer
  • colorectal surgery
  • low anastomoses
  • laparoscopic surgery
  • radiotherapy
  • indocyanine green
  • Received October 2, 2021.
  • Revision received October 24, 2021.
  • Accepted October 27, 2021.
  • Copyright © 2022 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
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Anticancer Research: 42 (1)
Anticancer Research
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The Role of Indocyanine Green in Laparoscopic Low Anterior Resections for Rectal Cancer Previously Treated With Chemo-radiotherapy: A Single-center Retrospective Analysis
ANTONIO BRESCIA, EDOARDO MARIA MUTTILLO, ILARIA ANGELICONE, ISABELLA MADAFFARI, FEDERICO MAGGI, ISABELLA SPERDUTI, MARCELLO GASPARRINI, MATTIA FALCHETTO OSTI
Anticancer Research Jan 2022, 42 (1) 211-216; DOI: 10.21873/anticanres.15475

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The Role of Indocyanine Green in Laparoscopic Low Anterior Resections for Rectal Cancer Previously Treated With Chemo-radiotherapy: A Single-center Retrospective Analysis
ANTONIO BRESCIA, EDOARDO MARIA MUTTILLO, ILARIA ANGELICONE, ISABELLA MADAFFARI, FEDERICO MAGGI, ISABELLA SPERDUTI, MARCELLO GASPARRINI, MATTIA FALCHETTO OSTI
Anticancer Research Jan 2022, 42 (1) 211-216; DOI: 10.21873/anticanres.15475
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Keywords

  • rectal cancer
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  • radiotherapy
  • indocyanine green
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