Assessing perfusion outcomes with Pinpoint Near-Infrared Flu
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Indocyanine green fluoroscopy has been shown to improve anastomotic leak rates in early phase trials. Researchers hypothesized that the use of fluoroscopy to ensure anastomotic perfusion may decrease anastomotic leak after low anterior resection.

Researchers performed a 1: 1 randomized controlled parallel study. Recruitment of 450 to 1000 patients was planned over 2 years. Included patients were those undergoing resection defined as anastomosis within 10 cm of the anal verge. A total of 25 centers recruited 347 patients, of whom 178 were randomly assigned to perfusion and 169 to standard.

- Neoadjuvant chemoradiation was performed in 63.5% of perfusion and 65.7% of standard. The mean level of anastomosis was 5.2 ± 3.1 cm in perfusion compared with 5.2 ± 3.3 cm in standard.

- Sufficient visualization of perfusion was reported in 95.4% of patients in the perfusion group.

- Postoperative abscess requiring surgical management was reported in 5.7% of perfusion and 4.2% of standard. Anastomotic leak was reported in 9.0% of perfusion compared with 9.6% of standard.

- On multivariate regression analysis, there was no difference in anastomotic leak rates between perfusion and standard.

In summary, successful visualization of perfusion can be achieved with indocyanine green fluoroscopy. However, no difference in anastomotic leak rates was observed between patients who underwent perfusion assessment versus standard surgical technique.

Diseases of the Colon & Rectum
Source: https://journals.lww.com/dcrjournal/Abstract/2021/08000/Perfusion_Assessment_in_Left_Sided_Low_Anterior.12.aspx
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