The role of intraoperative assessment of intestinal perfusion in preventing anastomotic leakage during surgical treatment of rectal cancer

Abstract

Anastomotic leakage (AL) is one of the most severe postoperative complications following surgical treatment of rectal cancer. Inadequate blood supply to the anastomotic site is a key pathophysiological factor contributing to AL. Traditional intraoperative perfusion assessment methods are subjective and limited in accuracy, prompting growing interest in objective approaches, particularly fluorescence angiography using indocyanine green (ICG). This study analyzed 107 patients with stage I–III rectal cancer who underwent anterior resection with colorectal anastomosis. Patients were divided into two groups: a control group (ICG (–), n = 54), where the resection margin was determined by clinical judgment, and a study group (ICG (+), n = 53), where intraoperative fluorescence angiography was additionally used to assess tissue perfusion. In the ICG (+) group, perfusion-related resection margin changes were made in 20.8% of cases. The results demonstrated a trend toward a lower overall AL rate in the ICG (+) group (5.6%) compared to the control group (18.1%), with an odds ratio of 0.26 (95% CI: 0.07–1.00; p = 0.072). A statistically significant reduction was observed for clinically relevant AL type B – 1.9% in the ICG (+) group versus 14.8 % in the control group (p = 0.031). These findings indicate that intraoperative use of ICG for objective assessment of bowel perfusion enables timely surgical adjustments and may reduce the incidence of anastomotic complications. The method is promising for routine clinical practice, especially in high-risk patients, though further research and standardization are needed.