Intraoperative use of indocyanine green fluorescence angiography reduced overall anastomotic leak rates by 14% in patients undergoing rectal cancer surgery compared with 21% of patients in the standard care group, according to a recent study.
The primary outcome of this randomized controlled trial was the rate of clinical anastomotic leak—defined as grade B or C—within 90 days postoperatively. Of the 698 patients included in the intention-to-treat analysis, 343 were assigned to the indocyanine green fluorescence angiography (ICG) group and 355 to the standard care group. Clinical leaks occurred in 36 patients (10%) in the ICG group compared with 54 (15%) in the standard care group. Although this difference did not meet the prespecified threshold for statistical significance, a significant reduction was observed in the rate of all anastomotic leaks (grades A, B, or C): 47 patients in the ICG group vs 74 in the standard care group. The use of ICG also resulted in more frequent intraoperative changes to the planned proximal transection level, occurring in 12% of patients in the ICG group compared with 7% in the standard care group. Rates of intraoperative complications (5% vs 4%), postoperative complications (38% vs 45%), and reinterventions within 90 days (18% vs 22%) were similar between groups. No serious adverse events were attributed to ICG use.
The IntAct trial enrolled 766 adults across 28 specialist rectal cancer centers in 8 European countries. Participants who were all medically eligible for elective laparoscopic or robotic surgery were randomized in a 1:1 ratio to receive either standard white-light perfusion assessment or ICG fluorescence angiography, involving two intravenous boluses of 0.1 mg/kg administered before and after anastomosis.
The researchers, led by Professor David Jayne, MD, of the Leeds Institute of Medical Research, University of Leeds, Leeds, UK, concluded that while ICG fluorescence angiography did not significantly reduce clinical anastomotic leaks, the observed reduction in overall leak rates and favorable safety profile indicate potential value and support the need for further investigation.
Full disclosures can be found in the published study.
