Interpretation and clinical utility of indocyanine-green fluorescence imaging (IFI) in robot-assisted anorectal-function saving operations (ASOs): A propensity-score matched analysis of 872 prospectively enroled patients undergoing IFI

Abstract

Background: This study suggested a novel physiological evaluation of indocyanine-green fluorescence imaging (IFI), and its utility associated with anastomotic leakage/stricture (AL/AS) and prognosis.

Methods: This study focussed on the utility of IFI, comparing IFI + versus IFI- groups (n = 878 vs. 339), optimised by propensity-score matching. After intravenous injection of indocyanine green, maximal perfusion was separately assessed at the vasa recta (VR) and colonic wall (CW), by determining intensities at the VR (VRI) and CW (CWI) and respective time.

Results: Although IFI did not significantly reduce either AL or AS, which occurred approximately 3-fold frequently in patients with lower than higher intensity of VRI. IFI was found as an independent parameter for both disease-free [DFS: hazard ratio (HR) = 0.489; p = 0.002] and overall survival (OS: HR = 0.519; p = 0.021).

Conclusions: Although IFI did not significantly reduce AL/AS, IFI independently reduced 5-year systemic recurrence and increased 5-year DFS and OS.

Keywords: anastomotic complication; anorectal-function saving operation (ASO); indocyanine-green fluorescence imaging (IFI); prognosis; robot-assisted.