Gabriella Schivardi, Lucia Ribero, Marina Rosanu, Diletta Fumagalli, Cristina Taliento, Giuseppe Caruso, Luigi de Vitis, Sara Gandini, Aurora Gaeta, Ilaria Betella, Maria Teresa Achilarre, Alessia Aloisi, Annalisa Garbi, Livia Xhindoli, Nicoletta Colombo, Vanna Zanagnolo, Angelo Maggioni, Roberto Biffi, Francesco Multinu, Giovanni Damiano Aletti
In this retrospective cohort study of patients undergoing cytoreductive surgery for stage III to IV ovarian cancer, use of indocyanine green fluorescence angiography was independently associated with a significantly lower rate of rectosigmoid anastomotic leak compared with conventional assessment. These findings support the use of indocyanine green fluorescence angiography as an adjunct intraoperative tool to reduce the risk of anastomotic leak.
OBJECTIVE: To evaluate whether the use of indocyanine green fluorescence angiography was associated with a reduced risk of anastomotic leak after rectosigmoid resection in patients undergoing cytoreductive surgery for International Federation of Gynecology and Obstetrics stage III to IV epithelial ovarian cancer.
METHODS: We performed a single-center retrospective cohort study of consecutive patients with stage III to IV epithelial ovarian, fallopian tube, or primary peritoneal cancer who underwent primary or interval cytoreductive surgery with rectosigmoid resection and anastomosis between January 2009 and December 2023. Patients treated from 2020-2023 underwent indocyanine green fluorescence angiography in addition to conventional perfusion assessment; those treated from 2009-2019 underwent conventional perfusion assessment (visual inspection of anastomotic tension and intraoperative air leak testing) alone. Multivariable logistic regressions were used to identify predictors of anastomotic leak.
RESULTS: Among 795 patients included, 556 (70.0%) underwent surgery before indocyanine green fluorescence angiography adoption and 239 (30.0%) after. Overall, 45 patients (5.7%) developed an anastomotic leak. Leak rates were significantly lower in the indocyanine green fluorescence angiography group compared with the group without indocyanine green fluorescence angiography (2.5% vs 7.0%; p =.01). In multivariable analysis, use of indocyanine green fluorescence angiography was independently associated with a lower risk of anastomotic leak (odds ratio 0.37, 95% confidence interval 0.14 to 0.83, p =.03).
CONCLUSIONS: In this retrospective cohort study of patients undergoing cytoreductive surgery for stage III to IV ovarian cancer, use of indocyanine green fluorescence angiography was independently associated with a significantly lower rate of rectosigmoid anastomotic leak compared with conventional assessment. These findings support the use of indocyanine green fluorescence angiography as an adjunct intraoperative tool to reduce the risk of anastomotic leak.