부산대학교 도서관

Simple Summary: Near-infrared indocyanine green (ICG)-enhanced fluorescence has been advocated as a reliable real-time technique to assess bowel perfusion during anastomosis formation in colorectal surgery. However, to date, no standardized protocols nor a quantitative imaging assessment are available. The aim of this study was to evaluate the timing of fluorescence as a reproducible, cost-effective parameter and its efficacy in predicting anastomotic leakage. The authors confirmed that patients with a longer perfusion timing, identified as delta timing, are at risk of developing anastomotic leakages. Furthermore, a real-time evaluation of a delta-timing/heart rate interaction provided a sensitive cut-off value to predict anastomotic leakage. The analysis of the timing of fluorescence can be easily applied during intraoperative ICG-enhanced fluorescence and may be used as a quantitative, objective parameter to guide surgical decision making. Background: To date, no standardized protocols nor a quantitative assessment of the near-infrared fluorescence angiography with indocyanine green (NIR-ICG) are available. The aim of this study was to evaluate the timing of fluorescence as a reproducible parameter and its efficacy in predicting anastomotic leakage (AL) in colorectal surgery. Methods: A consecutive cohort of 108 patients undergoing minimally invasive elective procedures for colorectal cancer was prospectively enrolled. The difference between macro and microperfusion (ΔT) was obtained by calculating the timing of fluorescence at the level of iliac artery division and colonic wall, respectively. Results: Subjects with a ΔT ≥ 15.5± 0.5 s had a higher tendency to develop an AL (p < 0.01). The ΔT/heart rate interaction was found to predict AL with an odds ratio of 1.02 (p < 0.01); a cut-off threshold of 832 was identified (sensitivity 0.86, specificity 0.77). Perfusion parameters were also associated with a faster bowel motility resumption and a reduced length of hospital stay. Conclusions: The analysis of the timing of fluorescence provides a quantitative, easy evaluation of tissue perfusion. A ΔT/HR interaction ≥832 may be used as a real-time parameter to guide surgical decision making in colorectal surgery. [ABSTRACT FROM AUTHOR]