Sphincter-saving surgery versus abdominoperineal resection in low rectal cancer: the role of indocyanine green fluorescence angiography in surgical decision-making - Report - MDSpire
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Sphincter-saving surgery versus abdominoperineal resection in low rectal cancer: the role of indocyanine green fluorescence angiography in surgical decision-making
Clinical Report: Comparing Sphincter-Sparing Surgery and Abdominoperineal Resection
Overview
This study evaluates the impact of indocyanine green fluorescence angiography (ICG-FA) on surgical decisions for low rectal cancer. ICG-FA modified the resection line in 40% of cases.
Background
Low rectal cancer poses significant challenges in surgical management, particularly in balancing oncological outcomes with functional preservation. The introduction of ICG-FA aims to enhance intraoperative decision-making by assessing bowel perfusion, a critical factor in preventing anastomotic failure.
Data Highlights
Parameter
Value
Patients with low rectal cancer
70
Patients undergoing sphincter-saving surgery
27
ICG-FA performed
22 (81.5%)
Modification of resection line due to ICG-FA
9 (40%)
R0 resection achieved
19 of 21
Postoperative complications
15 of 27 (56%)
Key Findings
ICG-FA was performed in 81.5% of patients undergoing sphincter-saving surgery.
Modification of the resection line occurred in 40% of cases where ICG-FA was utilized.
R0 resection was achieved in 90.5% of patients with recorded margin status.
Postoperative complications were observed in 56% of patients, primarily classified as Clavien–Dindo grade I–II.
No 30-day mortality was reported; one late in-hospital death occurred due to myocardial infarction.
Clinical Implications
The use of ICG-FA may assist surgeons in making informed intraoperative decisions regarding resection lines. However, the high rate of postoperative complications highlights the need for careful patient management.
Conclusion
Sphincter-saving surgery for low rectal cancer is feasible but associated with significant morbidity.
