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  • Routine use of ICG...

Routine use of ICG Fluorescence Imaging may not reduce overall anastomotic leak rate in laparoscopic colorectal surgery: JAMA

Written By : Dr Riya Dave |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2025-03-24T21:15:00+05:30  |  Updated On 25 March 2025 11:35 AM IST
Routine use of ICG Fluorescence Imaging may not reduce overall anastomotic leak rate in laparoscopic colorectal surgery: JAMA
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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

JAMA SurgeryICG fluorescence imagingcolorectal surgeryanastomotic leakagelaparoscopic resectionperfusion assessmentnear-infrared imagingbowel anastomosispatient outcomessurgical innovationrandomized trial
Source : JAMA Surgery
Dr Riya Dave
Dr Riya Dave

    Dr Riya Dave has completed dentistry from Gujarat University in 2022. She is a dentist and accomplished medical and scientific writer known for her commitment to bridging the gap between clinical expertise and accessible healthcare information. She has been actively involved in writing blogs related to health and wellness.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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