Evaluating the Effect of Intraoperative Near-Infrared Observation on Anastomotic Leakage after Stapled Side-To-Side Anastomosis in Colon Cancer Surgery Using Propensity Score-Matching.

BACKGROUND Recent studies have clarified that near-infrared observation using indocyanine green has the advantage of evaluating perfusion of the anastomotic site, especially in rectal cancer surgery, resulting in a reduction in anastomotic leak. OBJECTIVE The aim of this study was to evaluate the efficacy of near-infrared observation for reducing the anastomotic leak after stapled side-to-side anastomosis in colon cancer surgery. DESIGN This was a retrospective propensity score case-matched study. SETTINGS The study was conducted at three institutions in the Yokohama Clinical Oncology Group. PATIENTS From January 2011 to December 2019, patients who underwent colon cancer surgery with stapled side-to-side anastomosis were included. MAIN OUTCOME MEASURES The main outcome was the percentage of anastomotic leak within 30 days after surgery. RESULTS A total of 1034 patients were collected. There were 532 patients who underwent near-infrared observation and 502 who did not. A total of 370 patients were matched to the near-infrared and non-near-infrared groups. In the near-infrared group, 12 cases (3.2%) was judged to have poor perfusion (4 cases) and no perfusion (8 cases), so the planned transection point was changed. There were no cases of anastomotic leak among these 12 cases. The anastomotic leak rates were 3.5% (13/370) in the non-near-infrared group and 0.8% (3/370) in the near-infrared group. The anastomotic leak and reoperation rates were significantly lower in the near-infrared group than in the non-near-infrared group (odds ratio 0.224, 95% confidence interval 0.063-0.794, p=0.001; odds ratio 0.348, 95% confidence interval 0.124-0.977, p=0.036, respectively). LIMITATIONS Although we reduced selection bias by performing propensity score-matching, this was a retrospective study and was not randomized. CONCLUSION This large-scale case-matched study showed that assessing perfusion by near-infrared observation significantly reduced the anastomotic leak and reoperation rates after stapled side-to-side anastomosis in colon cancer surgery and may be better suited to colo-colonic anastomosis. Japanese Clinical Trials Registry: UMIN-CTR000039977 Video Abstract at http://links.lww.com/DCR/B513.