Quantitative analysis of colon perfusion pattern using indocyanine green (ICG) angiography in laparoscopic colorectal surgery

Gyung Mo Son; Myeong Sook Kwon; Yoonhong Kim; Jisu Kim; Seung Hwa Kim; Jung Woo Lee

doi:10.1007/s00464-018-6439-y

Quantitative analysis of colon perfusion pattern using indocyanine green (ICG) angiography in laparoscopic colorectal surgery

Surg Endosc. 2019 May;33(5):1640-1649. doi: 10.1007/s00464-018-6439-y. Epub 2018 Sep 10.

Authors

Gyung Mo Son¹, Myeong Sook Kwon², Yoonhong Kim³, Jisu Kim⁴, Seung Hwa Kim⁵, Jung Woo Lee⁵

Affiliations

¹ Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam-do, 50612, Republic of Korea. skm1711@pusan.ac.kr.
² Medical Research Institute, Pusan National University, Busan, Republic of Korea.
³ Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam-do, 50612, Republic of Korea.
⁴ Department of Medicine, School of Medicine, Pusan National University, Yangsan, Gyeongsangnam-do, Republic of Korea.
⁵ Department of Medical Image Analysis, Withpia.co, Busan, Republic of Korea.

Abstract

Purpose: This study aimed to quantitatively evaluate colon perfusion patterns using indocyanine green (ICG) angiography to find the most reliable predictive factor of anastomotic complications after laparoscopic colorectal surgery.

Methods: Laparoscopic fluorescence imaging was applied to colorectal cancer patients (n = 86) from July 2015 to December 2017. ICG (0.25 mg/kg) was slowly injected into peripheral blood vessels, and the fluorescence intensity of colonic flow was measured sequentially, producing perfusion graphs using a video analysis and modeling tool. Colon perfusion patterns were categorized as either fast, moderate, or slow based on their fluorescence slope, T_1/2MAX and time ratio (TR = T_1/2MAX/T_MAX). Clinical factors and quantitative perfusion factors were analyzed to identify predictors for anastomotic complications.

Results: The mean age of patients was 65.4 years, and the male-to-female ratio was 63:23. Their operations were laparoscopic low anterior resection (55 cases) and anterior resection (31 cases). The incidence of anastomotic complication was 7%, including colonic necrosis (n = 1), anastomotic leak (n = 3), delayed pelvic abscess (n = 1), and delayed anastomotic dehiscence (n = 1). Based on quantitative analysis, the fluorescence slope, T_1/2MAX, and TR were related with anastomotic complications. The cut-off value of TR to categorize the perfusion pattern was determined to be 0.6, as shown by ROC curve analysis (AUC 0.929, P < 0.001). Slow perfusion (TR > 0.6) was independent factor for anastomotic complications in a logistic regression model (OR 130.84; 95% CI 6.45-2654.75; P = 0.002). Anastomotic complications were significantly correlated with the novel factor TR (> 0.6) as the most reliable predictor of perfusion and anastomotic complications.

Conclusions: Quantitative analysis of ICG perfusion patterns using T_1/2MAX and TR can be applied to detect segments with poor perfusion, thereby reducing anastomotic complications during laparoscopic colorectal surgery.

Keywords: Anastomotic complications; Colorectal surgery; Indocyanine green; Intraoperative angiography; Laparoscopy; Quantitative analysis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Anastomosis, Surgical / methods
Anastomotic Leak / diagnosis*
Anastomotic Leak / etiology
Angiography / methods*
Colon / blood supply*
Colon / surgery
Colonic Neoplasms / surgery*
Colorectal Neoplasms / surgery*
Colorectal Surgery / methods*
Digestive System Surgical Procedures / adverse effects
Female
Humans
Indocyanine Green / administration & dosage*
Laparoscopy / methods*
Male
Middle Aged
Postoperative Complications / diagnosis
Predictive Value of Tests

Substances

Indocyanine Green