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Session: ePoster: Colon and Colorectal Cancer 1 (Sun8)

EP266 - Preventing Colon Ischemia in Laparoscopic Colorectal Cancer Surgery Using Indocyanine Green Fluorescence Imaging : Propensity Score Matching Analysis

Sunday, May 11, 2025
9:33 AM – 9:38 AM PT
Location: Monitor 4, Sails Pavilion, Upper Level

    Author(s)

  • MK

    Moon Jin Kim, 118701

    Colorectal Surgeon, Clinical Assistant Professor, Department of surgery
    Incheon Saint Mary Hospital
    Incheon, Inch'on-jikhalsi, Republic of Korea

    Disclosure information not submitted.

    • Senior Author(s)

  • JK

    Ji Hoon Kim, 81504

    Colorectal Surgeon, Associate Professor, Department of Surgery
    Incheon Saint Mary Hospital
    Incheon, Inch'on-jikhalsi, Republic of Korea

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • ePoster Presenter(s)

  • Ju Myung Song, 109802

    Colorectal surgeon, Clinical Assistant Professor, Department of Surgery
    Incheon Saint Mary Hospital
    Incheon, Inch'on-jikhalsi, Republic of Korea

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Ji Hoon Kim, 81504: This individual has no financial relationships with ineligible companies.
Ju Myung Song, 109802: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Fluorescent staining with Indocyanine Green Fluorescence (ICG) has shown many benefits in surgery over the past decade. In particular, near-infrared light can be used to visualize blood vessels during colorectal surgery to confirm blood flow before resecting the bowel. Since the inferior mesenteric artery is ligated during surgery for left colon or rectal cancer, preserving blood flow is one of the important factors for resection. In this paper, we will analyze the impact and benefits of ICG in real colorectal surgery cases.

Methods/Interventions: Patients who underwent laparoscopic surgery for left colon cancer (splenic flexure, descending, sigmoid colon) or rectal cancer at Incheon St. Mary's Hospital from January 2012 to December 2023 were retrospectively analyzed and propensity score matched according to whether or not intraoperative ICG was performed. Patients who underwent open surgery, patients with right colon cancer, and surgery without anastomosis were excluded from the study. There were 1362 patients in the No ICG group and 730 patients in the ICG group. The characteristics of each group, the rate of intraoperative re-resection, the rate of postoperative colon ischemia, and other morbidities were compared using the chi-square test. 1:1 propensity score matching (PSM) analysis was performed.

Results/Outcomes: Before propensity score matching, there were differences between the two groups in patient characteristics such as male/female sex ratio, proportion of rectal cancer, ASA score, and operation history. After propensity score matching, all characteristics were not significantly different. The rate of re-resection was higher in the ICG group before PSM (No ICG group vs ICG group: 1.2% vs 4.1%, p< 0.001), and after PSM the rate was also elevated in the ICG group. (1.8% vs 4.1%, p=0. 013) When the reason for re-resection was analyzed as suspected ischemia and other reasons such as stapler failure, the rate of re-resection for suspected ischemia was higher in the ICG group. (after PSM: 1.4% vs 3.3%, p=0.031) Anastomosis leak, colon ischemia, and other morbidities were not significantly different between the two groups before and after PSM. Among patients who developed ischemia or leak, surgical repair rate was slightly lower in the ICG group (38% vs 26.9%), but this was not statistically significant. (p=0.236)

Conclusion/Discussion: ICG during laparoscopic colorectal surgery can detect colon ischemia with a higher probability and prevent life threatening events by performing intraoperative re-excision. There was no significant difference in morbidity, but there was a trend toward a decrease in anastomosis leak severity in the ICG group.