Castellà utilidad de la angiografía mediante verde de indocianina para la prevención del fallo de sutura en cirugía colorrectal
- Autores: Ana María Otero Piñeiro
- Directores de la Tesis: Antonio María de Lacy Fortuny (dir. tes.), José María Balibrea del Castillo (dir. tes.)
- Lectura: En la Universitat Autònoma de Barcelona ( España ) en 2018
- Idioma: español
- Tribunal Calificador de la Tesis: Manuel Armengol Carrasco (presid.), Antoni Codina Cazador (secret.), Raúl Almenara Santacristina (voc.)
- Programa de doctorado: Programa de Doctorado en Cirugía y Ciencias Morfológicas por la Universidad Autónoma de Barcelona
- Materias:
- Enlaces
- Tesis en acceso abierto en: TDX
- Resumen
Aims: Anastomotic leak (AL) is the most feared complication in colorectal surgery. Indocyanine Green (ICG) fluorescence angiography (FA) allows for a real-time intraoperative evaluation of bowel perfusion and is considered as a promising tool to reduce AL. This study aimed to assess the impact of ICG on perioperative outcomes in patients treated with transanal total mesorectal excision (TaTME) for rectal cancer.
Methods: All patients with rectal cancer treated at our hospital by TaTME between November 2011 and July 2017 were prospectively included in a standardized database. Our experience with FA started in March 2016, assessing bowel perfusion before proximal colonic transection and after the performance of the anastomosis. Hence, outcomes of the ICG group were compared with the historical cohort of non-ICG assessed patients. The primary endpoint was AL.
Results: A total of 254 patients were included in the analysis, 50 (19.7%) in the ICG group and 204 (80.3%) in the non-ICG group. Both groups did not differ in male-female ratio, median age, obesity, nor smoking rate. The majority of the patients were classified as ASA II. 137 patients (50.2% vs. 46.0%; p=0.760) underwent neoadjuvant chemoradiotherapy. Mean anastomotic height was 4.85 cm vs. 4,68 cm (p=0.985), splenic flexure mobilization was performed in 91 patients (34.3% vs. 42.0%; p=0.327), while a diverting stoma was constructed in 186 patients (72.1% vs. 78.0%; p=0.477). FA led to a change in the resection margin in 16 patients (32.0%) and to mobilization of the splenic flexure after anastomosis construction in 1 (2.0%) patient. AL was diagnosed in 1 patient (2.0%) in the ICG group and in 23 patients (11.3%) in the non-ICG group (p=0.056). Postoperative intraabdominal collection was diagnosed in 17 patients (7.4% vs. 6.0%; p=0.692), and reintervention was needed in 24 patients (10.8% vs. 4.0%; p=0.182). The median length of hospital stay was 5.8 days (6.0 vs. 5.0; p=0.037).
Conclusion: FA improved anastomotic leak rate and decreased the need for reintervention probably due to a change in surgical plans of more than one third of the patients. ICG should be considered as a routine assessment for high-risk colorectal anastomosis. Nonetheless, further research is needed.
