Routine use of ICG Fluorescence Imaging may not reduce overall anastomotic leak rate in laparoscopic colorectal surgery: JAMA
Researchers have found in a new study published in JAMA Surgery that indocyanine green (ICG) fluorescence imaging can potentially decrease anastomotic leakage in left-sided colorectal resections. Anastomotic leakage is a severe complication of colorectal surgery and usually results in extended hospitalization, increased morbidity, and increased mortality. The ICG-COLORAL study aimed to determine whether such technology is efficacious in reducing anastomotic leak during laparoscopic colorectal operations. The study was conducted by Juha K. A. and colleagues.
This randomized, multicenter, prospective trial had 1136 patients who underwent elective laparoscopic colorectal resections with planned primary anastomosis at five public hospitals in Finland. The trial, from September 2018 to December 2023, did not include low anterior resections. The participants were enrolled at preoperative outpatient clinic visits by researchers and clinicians not engaged in the study. The patients were randomized into two groups:
• ICG fluorescence imaging group (n = 567): Administered 5 mg of ICG intravenously before and after anastomosis creation, with perfusion measured by a near-infrared–equipped camera.
• Control group (n = 569): Did not undergo ICG fluorescence imaging.
The main outcome was the rate of anastomotic leak, ascertained through computed tomography (CT).
Key Findings
• The population in the study had a median age of 70 years (SD, 11), and 46.3% were female (n = 526) and 53.7% were male (n = 610). The median BMI was 28 (SD, 5), and the median Charlson Comorbidity Index was 5 (SD, 3).
Total anastomotic leak rate:
• ICG group: 5.8% (33/567)
• Control group: 7.9% (45/569)
• Odds ratio (OR): 0.73 (95% CI, 0.48-1.13; p=0.16)
Right-sided colorectal operations:
• ICG group: 5.9% (16/273)
• Control group: 6.7% (20/298)
• OR: 0.87 (95% CI, 0.46-1.65)
Left-sided colorectal surgeries:
• ICG group: 5.2% (14/267)
• Control group: 9.5% (23/243)
• OR: 0.55 (95% CI, 0.29-1.05)
No adverse events related to ICG were reported by any patients.
This study found that routine use of ICG fluorescence imaging does not significantly reduce the overall anastomotic leak rate in laparoscopic colorectal surgery, except for potential benefits in left-sided operations. The study supports continued investigation to improve the application of fluorescence imaging to colorectal surgery and to delineate patient subgroups that might benefit most from this technology.
Reference:
Rinne JKA, Huhta H, Pinta T, et al. Indocyanine Green Fluorescence Imaging in Prevention of Colorectal Anastomotic Leakage: A Randomized Clinical Trial. JAMA Surg. Published online March 05, 2025. doi:10.1001/jamasurg.2025.0006
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