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Markov N, Sabirova S, Sharapova G, Gomzikova M, Brichkina A, Barlev NA, Egger M, Rizvanov A, Simon HU. Mitochondrial, metabolic and bioenergetic adaptations drive plasticity of colorectal cancer cells and shape their chemosensitivity. Cell Death Dis 2025; 16:253. [PMID: 40185729 PMCID: PMC11971274 DOI: 10.1038/s41419-025-07596-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2025] [Revised: 03/17/2025] [Accepted: 03/24/2025] [Indexed: 04/07/2025]
Abstract
The extent of mitochondrial heterogeneity and the presence of mitochondrial archetypes in cancer remain unknown. Mitochondria play a central role in the metabolic reprogramming that occurs in cancer cells. This process adjusts the activity of metabolic pathways to support growth, proliferation, and survival of cancer cells. Using a panel of colorectal cancer (CRC) cell lines, we revealed extensive differences in their mitochondrial composition, suggesting functional specialisation of these organelles. We differentiated bioenergetic and mitochondrial phenotypes, which point to different strategies used by CRC cells to maintain their sustainability. Moreover, the efficacy of various treatments targeting metabolic pathways was dependent on the respiration and glycolysis levels of cancer cells. Furthermore, we identified metabolites associated with both bioenergetic profiles and cell responses to treatments. The levels of these molecules can be used to predict the therapeutic efficacy of anti-cancer drugs and identify metabolic vulnerabilities of CRC. Our study indicates that the efficacy of CRC therapies is closely linked to mitochondrial status and cellular bioenergetics.
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Affiliation(s)
- Nikita Markov
- Institute of Pharmacology, University of Bern, Bern, Switzerland
| | - Sirina Sabirova
- Laboratory of Molecular Immunology, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
- Laboratory of Intercellular Communication, Kazan Federal University, Kazan, Russia
| | - Gulnaz Sharapova
- Laboratory of Molecular Immunology, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
- OpenLab Gene and Cell Technology, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Marina Gomzikova
- Laboratory of Molecular Immunology, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
- Laboratory of Intercellular Communication, Kazan Federal University, Kazan, Russia
| | - Anna Brichkina
- Institute of Systems Immunology, Center for Tumor Biology and Immunology, Philipps University of Marburg, Marburg, Germany
| | - Nick A Barlev
- Laboratory of Molecular Immunology, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
- Institute of Cytology of the Russian Academy of Sciences, St. Petersburg, Russia
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Marcel Egger
- Department of Physiology, University of Bern, Bern, Switzerland
| | - Albert Rizvanov
- OpenLab Gene and Cell Technology, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
- Division of Medical and Biological Sciences, Tatarstan Academy of Sciences, Kazan, Russia
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland.
- Laboratory of Molecular Immunology, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia.
- Institute of Biochemistry, Brandenburg Medical School, Neuruppin, Germany.
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Zhang XQ, Zhang CF, Zhou XJ, Shuai LY, Peng D, Ji GY. Evaluation of anastomotic blood supply during digestive tract reconstruction with the use of the oxygen saturation index: A pooling up analysis. Int J Colorectal Dis 2025; 40:71. [PMID: 40102303 PMCID: PMC11920329 DOI: 10.1007/s00384-025-04864-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2024] [Indexed: 03/20/2025]
Abstract
PURPOSE Anastomotic leakage (AL) is one of the most serious clinical complications in digestive tract reconstruction (DTR) surgery, and it is currently hypothesized that this may be related to insufficient anastomotic blood supply. Thus, Therefore, we aimed to assess the ability of tissue oxygen saturation(StO2) as a measure to evaluate anastomotic blood supply. METHODS A comprehensive literature search was performed using Embase, PubMed and Cochrane Library. StO2 was used as an evaluation index of anastomotic blood supply after DTR to analyze the potential association between this index and the occurrence of AL in the postoperative period. RESULTS A total of eleven articles involving 867 participants were included in this systematic review and meta-analysis. After pooling the standardized mean difference (SMD) and 95% confidence intervals (Cls), low StO2 was found to be an independent risk factor for AL (P < 0.00001; 95%CI: 1.02 [0.53-1.51]). The mean StO2 in the AL group (62.3%) was significantly lower than that in the non-AL group (74.3%); AL incidence increased with the reduction of StO2 to a certain value to 201.8% and 338.1% respectively. CONCLUSION Oxygen saturation index can be utilized in DTR to accurately and quantitatively evaluate the anastomotic blood supply to reduce the probability of postoperative AL.
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Affiliation(s)
- Xiao-Qiang Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China
| | - Chao-Fu Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China
| | - Xiang-Jun Zhou
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China
| | - Lei-Yuan Shuai
- Department of Anorectal Surgery, Jiangjin Central Hospital of Chongqing, Chongqing, 404000, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China
| | - Guang-Yan Ji
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China.
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Singaravelu A, Entee PDM, Boland PA, Moynihan A, McCarrick C, Vahrmeijer AL, Arezzo A, Boni L, Hompes R, Cahill RA. Colorectal surgeons' perspectives on the efficacy of intraoperative bowel perfusion technology with a focus on indocyanine green fluorescence angiography. Langenbecks Arch Surg 2025; 410:73. [PMID: 39961820 PMCID: PMC11832565 DOI: 10.1007/s00423-025-03640-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Accepted: 02/05/2025] [Indexed: 02/20/2025]
Abstract
BACKGROUND Level one evidence supports indocyanine green fluorescence angiography (ICGFA) use reducing anastomotic leak rates in colorectal surgery. We surveyed surgeons exploring perceptions and factors affecting its use in daily practice and adoption as routine standard of care. METHODS Validated electronic survey distributed via the Irish Association of Coloproctology, Royal College of Surgeons in Ireland, European Society of Surgical Oncology, European Association for Endoscopic Surgery, Milan Colorectal Congress and social media. RESULTS 200 colorectal surgeons (143 consultants) responded. 147 (73.5%) surgeons already use ICGFA, with 90 (61.2%) using it routinely and 69 (46.9%) having a concomitant research interest. Strong clinical evidence base (83.5%) and protocol standardisation (78%) were overall rated most important for bowel perfusion technology with a majority of surgeons rating lack of standardisation and inter-user variability as challenges (similar between consultants and non-consultants). Lack of training and staff, reliability concerns and data security were perceived as significant barriers by selective users compared to non-users, and cost and operating time were perceived as significant barriers by selective users compared to routine users. Most surgeons (41.5%) ideated a number needed to treat (NNT) between 20 and 40 acceptable to advocate routine ICGFA use with 28% requiring a NNT < 20. Most surgeons (38.5%) indicate a per case cost savings of €250-500 supports routine use with 17% advocating it > €750. CONCLUSIONS With now a strong evidence base regarding clinical benefit, the survey respondents articulate remaining challenges for ICGFA as standard of care. Levels of expected benefit are largely in keeping with its reported performance.
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Affiliation(s)
- Ashokkumar Singaravelu
- UCD Centre for Precision Surgery, University College Dublin, 47 Eccles St, Dublin, Ireland
| | - Philip D Mc Entee
- UCD Centre for Precision Surgery, University College Dublin, 47 Eccles St, Dublin, Ireland
| | - Patrick A Boland
- UCD Centre for Precision Surgery, University College Dublin, 47 Eccles St, Dublin, Ireland
| | - Alice Moynihan
- UCD Centre for Precision Surgery, University College Dublin, 47 Eccles St, Dublin, Ireland
| | - Cathleen McCarrick
- UCD Centre for Precision Surgery, University College Dublin, 47 Eccles St, Dublin, Ireland
| | | | - Alberto Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Luigi Boni
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Roel Hompes
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Ronan A Cahill
- UCD Centre for Precision Surgery, University College Dublin, 47 Eccles St, Dublin, Ireland.
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
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Charbonneau J, Papillon-Dion É, Brière R, Singbo N, Legault-Dupuis A, Drolet S, Rouleau-Fournier F, Bouchard P, Bouchard A, Thibault C, Letarte F. Fluorescence angiography with indocyanine green for low anterior resection in patients with rectal cancer: a prospective before and after study. Tech Coloproctol 2025; 29:45. [PMID: 39810013 DOI: 10.1007/s10151-024-03075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 11/24/2024] [Indexed: 01/16/2025]
Abstract
BACKGROUND Inadequate bowel perfusion is among risk factors for colorectal anastomotic leaks. Perfusion can be assessed with indocyanine green fluorescence angiography (ICG) during colon resections. Possible benefits from its systematic use in high-risk patients with rectal cancer remain inconsistent. This study aimed to evaluate the surgical modifications induced by ICG assessment during rectal cancer surgery and associated anastomotic leaks. METHODS This prospective before and after cohort study was conducted in a single Canadian high-volume colorectal surgery center. Eligible patients were undergoing a low anterior resection for rectal cancer below 15 cm from the anal margin. Stapled and handsewn coloanal anastomoses were included. The experimental group was recruited prospectively, undergoing surgery using fluorescence angiography with ICG. The control group was built retrospectively from consecutive patients who had been operated on without ICG, prior to its implementation. RESULTS Each cohort included 113 patients. The use of ICG led to modifications from initial surgical plan in 10.6% of patients, with no occurrence of anastomotic leaks in this specific group. When comparing leak rates, using ICG seemed to be protective, but this could not be statistically proven, overall (13.3% vs. 6.2%, p = 0.07), nor for handsewn coloanal anastomoses (11.8% vs. 5.9%, p = 0.67). A lack of power could explain such non-significant results, especially with low overall anastomotic leak rates recorded. CONCLUSION ICG influenced ultimate proximal resection margin in a clinically relevant proportion of cases. It might be associated with reduced leak rates although not formally proven with this data. This technology is safe and easy to apply in high-volume colorectal centers.
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Affiliation(s)
- J Charbonneau
- Université Laval, 10, De l'Espinay St, Quebec City, QC, G1L 3L5, Canada.
- CHU de Québec-Université Laval, Quebec City, Canada.
| | - É Papillon-Dion
- Université Laval, 10, De l'Espinay St, Quebec City, QC, G1L 3L5, Canada
| | - R Brière
- Université Laval, 10, De l'Espinay St, Quebec City, QC, G1L 3L5, Canada
- CHU de Québec-Université Laval, Quebec City, Canada
| | - N Singbo
- CHU de Québec-Université Laval, Quebec City, Canada
| | - A Legault-Dupuis
- Université Laval, 10, De l'Espinay St, Quebec City, QC, G1L 3L5, Canada
| | - S Drolet
- Université Laval, 10, De l'Espinay St, Quebec City, QC, G1L 3L5, Canada
- CHU de Québec-Université Laval, Quebec City, Canada
| | - F Rouleau-Fournier
- Université Laval, 10, De l'Espinay St, Quebec City, QC, G1L 3L5, Canada
- CHU de Québec-Université Laval, Quebec City, Canada
| | - P Bouchard
- Université Laval, 10, De l'Espinay St, Quebec City, QC, G1L 3L5, Canada
- CHU de Québec-Université Laval, Quebec City, Canada
| | - A Bouchard
- Université Laval, 10, De l'Espinay St, Quebec City, QC, G1L 3L5, Canada
- CHU de Québec-Université Laval, Quebec City, Canada
| | - C Thibault
- Université Laval, 10, De l'Espinay St, Quebec City, QC, G1L 3L5, Canada
- CHU de Québec-Université Laval, Quebec City, Canada
| | - F Letarte
- Université Laval, 10, De l'Espinay St, Quebec City, QC, G1L 3L5, Canada
- CHU de Québec-Université Laval, Quebec City, Canada
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Agnesi S, Virgilio F, Frontali A, Zoni G, Giugliano M, Missaglia C, Balla A, Sileri P, Vignali A. Inferior mesenteric artery preservation techniques in the treatment of diverticular disease: a systematic review of the literature. Int J Colorectal Dis 2024; 39:174. [PMID: 39466460 PMCID: PMC11519083 DOI: 10.1007/s00384-024-04746-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2024] [Indexed: 10/30/2024]
Abstract
PURPOSE The aim of this study is to analyze the impact of different surgical techniques used to preserve the inferior mesenteric artery on patient outcomes following left colonic resection. METHODS A search was conducted in PubMed, Embase and Web of Science, founding 4795 articles. The review was registered on PROSPERO (registration number: CRD42024572291). RESULTS Eleven articles published between 2001 and 2023, including 989 patients were the object of the present systematic review. Two hundred sixty-two patients (26.5%) underwent Valdoni's technique (Group A), which involves the skeletonization of the IMA, 272 (27.5%) underwent tubular resection (Group B), and 455 (46%) underwent peripheral dissection on sigmoid vessels (Group C). Laparoscopic surgery was predominant in Groups B (100%) and C (94.7%), while Group A had fewer laparoscopic procedures (44.6%). Patients in Group A experienced longer operative times (174.5 ± 27.4 min) and hospital stays (11.4 ± 3.6 days) compared to Groups B and C (165.9 min and 152.35 ± 46.9 min; 8.4 ± 5.7 days and 8.3 ± 3.6 days, respectively). Group A exhibited higher rates of anastomotic leakage (5%) compared to Group C (1.1%) and a higher incidence of bleeding (13%) compared to Group B (1.8%). CONCLUSION Valdoni's technique is less favourable for IMA preservation in left colon resection for diverticular disease. Peripheral dissection of sigmoid vessels or tubular resection is recommended for IMA preservation in this context.
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Affiliation(s)
- Stefano Agnesi
- Colorectal Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, 20132, Italy.
| | - Francesco Virgilio
- Colorectal Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, 20132, Italy
| | - Alice Frontali
- Colorectal Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, 20132, Italy
| | - Greta Zoni
- Colorectal Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, 20132, Italy
| | - Mariagiulia Giugliano
- Colorectal Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, 20132, Italy
| | - Claudio Missaglia
- Colorectal Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, 20132, Italy
| | - Andrea Balla
- Colorectal Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, 20132, Italy
| | - Pierpaolo Sileri
- Colorectal Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, 20132, Italy
| | - Andrea Vignali
- Colorectal Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, 20132, Italy
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Miyazaki D, Shichinohe T, Watanabe Y, Tanaka K, Nakanishi Y, Asano T, Kurashima Y, Ebihara Y, Murakami S, Hirano S. The relationship between perioperative central venous oxygen saturation and postoperative complications in highly invasive gastroenterological surgery. Ann Gastroenterol Surg 2024; 8:660-667. [PMID: 38957557 PMCID: PMC11216792 DOI: 10.1002/ags3.12768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/23/2023] [Accepted: 12/12/2023] [Indexed: 07/04/2024] Open
Abstract
Purpose Operations for malignant diseases of the bile duct, pancreas, and esophagus are the most invasive gastroenterological surgeries. The frequency of complications after these surgeries is high, which affects the postoperative course and mortality. In patients who undergo these types of surgeries, continuous monitoring of the perioperative central venous oxygen saturation (ScvO2) is possible via a central venous catheter. We aimed to investigate the relationship between continuously monitored perioperative ScvO2 values and postoperative complications. Methods The medical records of 115 patients who underwent highly invasive gastroenterological surgeries and ScvO2 monitoring from April 2012 to March 2014 were analyzed. Sixty patients met the inclusion criteria, and their ScvO2 levels were continuously monitored perioperatively. The relationship between ScvO2 levels and major postoperative complications, defined as Clavien-Dindo grade ≥ III, was examined using uni- and multivariate analysis. Results Thirty patients developed major postoperative complications. The adequate cut-off value derived from receiver operating curves of the postoperative average ScvO2 levels for predicting major complications was 75%. Multivariate analysis revealed that low average postoperative ScvO2 levels (p = 0.016) and blood loss ≥ 1000 mL (p = 0.039) were significant predictors of major postoperative complications. Conclusions Low perioperative ScvO2 values were associated with an increased risk of major postoperative complications. Continuous ScvO2 monitoring will help prevent postoperative complications.
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Affiliation(s)
- Dai Miyazaki
- Department of Gastroenterological Surgery IIHokkaido University Faculty of MedicineSapporoJapan
| | - Toshiaki Shichinohe
- Department of Gastroenterological Surgery IIHokkaido University Faculty of MedicineSapporoJapan
| | - Yusuke Watanabe
- Department of Gastroenterological Surgery IIHokkaido University Faculty of MedicineSapporoJapan
| | - Kimitaka Tanaka
- Department of Gastroenterological Surgery IIHokkaido University Faculty of MedicineSapporoJapan
| | - Yoshitsugu Nakanishi
- Department of Gastroenterological Surgery IIHokkaido University Faculty of MedicineSapporoJapan
| | - Toshimichi Asano
- Department of Gastroenterological Surgery IIHokkaido University Faculty of MedicineSapporoJapan
| | - Yo Kurashima
- Department of Gastroenterological Surgery IIHokkaido University Faculty of MedicineSapporoJapan
| | - Yuma Ebihara
- Department of Gastroenterological Surgery IIHokkaido University Faculty of MedicineSapporoJapan
| | - Soichi Murakami
- Department of Gastroenterological Surgery IIHokkaido University Faculty of MedicineSapporoJapan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery IIHokkaido University Faculty of MedicineSapporoJapan
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Trentadue G, Mensink PBF, Kruse C, Reszel B, Kats-Ugurlu G, Blokzijl T, Haveman JW, Faber KN, Dijkstra G, Hölscher UM, Kolkman JJ, Knichwitz G. Intraluminal oxygen can keep small bowel mucosa intact in a segmental ischemia model. Sci Rep 2024; 14:13732. [PMID: 38877069 PMCID: PMC11178904 DOI: 10.1038/s41598-024-64660-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 06/11/2024] [Indexed: 06/16/2024] Open
Abstract
Intestinal preservation for transplantation is accompanied by hypoperfusion with long periods of ischemia with total blood cessation and absolute withdrawal of oxygen leading to structural damage. The application of intraluminal oxygen has been successfully tested in small-animal series during storage and transport of the organ but have been so far clinically unrelatable. In this study, we tested whether a simple and clinically approachable method of intraluminal oxygen application could prevent ischemic damage in a large animal model, during warm ischemia time. We utilised a local no-flow ischemia model of the small intestine in pigs. A low-flow and high-pressure intraluminal oxygen deliverance system was applied in 6 pigs and 6 pigs served as a control group. Mucosal histopathology, hypoxia and barrier markers were evaluated after two hours of no-flow conditions, in both treatment and sham groups, and in healthy tissue. Macro- and microscopically, the luminal oxygen delivered treatment group showed preserved small bowel's appearance, viability, and mucosal integrity. A gradual deterioration of histopathology and barrier markers and increase in hypoxia-inducible factor 1-α expression towards the sites most distant from the oxygen application was observed. Intraluminal low-flow, high oxygen delivery can preserve the intestinal mucosa during total ischemia of the small intestine. This finding can be incorporated in methods to overcome small bowel ischemia and improve intestinal preservation for transplantation.
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Affiliation(s)
- Guido Trentadue
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.
| | - Peter B F Mensink
- Department of Internal Medicine and Gastroenterology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Claudius Kruse
- Department of Anaesthesiology, University Hospital Muenster, Muenster, Germany
- Department of Anaesthesiology and Operative Intensive Medicine, Franziskus Hospital, Intensive Care Medicine, Bielefeld, Germany
| | - Bernward Reszel
- CERES GmbH, Clinical Evaluation and Research, Lörrach, Germany
- Berufliche Fortbildungszentren der Bayerischen Wirtschaft (bfz) gGmbH, München, Germany
| | - Gursah Kats-Ugurlu
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tjasso Blokzijl
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Willem Haveman
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Klaas Nico Faber
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - Uvo M Hölscher
- Münster University of Applied Sciences, Steinfurt, Germany
| | - Jeroen J Kolkman
- Department of Internal Medicine and Gastroenterology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Gisbert Knichwitz
- Department of Anaesthesiology, University Hospital Muenster, Muenster, Germany
- Dreifaltigkeits-Krankenhaus Cologne, Klinik Für Anästhesiologie, Intensivmedizin Und Schmerztherapie, Cologne, Germany
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8
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Ma Z, Deng J, Ma B, Chen H. Real-time Indocyanine Green Fluorescence Technique Reduces Anastomotic Leakage in Bilioenteric Anastomosis: A Case Report and literature review. Photodiagnosis Photodyn Ther 2023:103609. [PMID: 37187271 DOI: 10.1016/j.pdpdt.2023.103609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/25/2023] [Accepted: 05/09/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Anastomotic leakage is a serious complication that can occur in bilioenteric anastomosis surgery, leading to significant morbidity and mortality. Currently, practitioners rely on subjective measures to determine anastomotic perfusion and mechanical integrity, which have limitations. The use of indocyanine green fluorescence technology has become increasingly widespread in clinical practice, especially in gastrointestinal-related surgery. This technique has a unique role in evaluating the blood perfusion of anastomoses and reducing the incidence of anastomotic leakage. However, there have been no reports of its use in bilioenteric anastomosis surgery. Further research is needed to investigate the potential benefits of indocyanine green fluorescence technology in improving outcomes and reducing complications in this type of surgery. CASE SUMMARY a 50-year-old female patient underwent total laparoscopic radical resection of cholangiocarcinoma. During the surgery, indocyanine green fluorescence technology was used to complete the biliary intestinal anastomosis under full visual and dynamic monitoring. The patient recovered well after the operation without experiencing biliary leakage or other complications. CONCLUSION The present case study underscores the potential advantages associated with the incorporation of intraoperative real-time indocyanine green (ICG) technology in bilioenteric anastomosis surgery. By facilitating enhanced visualization and assessment of anastomotic perfusion and mechanical stability, this state-of-the-art technique may help mitigate the occurrence of anastomotic leaks while simultaneously improving patient outcomes. Notably, intravenous administration of ICG at a dose of 2.5 mg/kg, administered 24 hours prior to surgery, has been found to yield optimal visualization outcomes.
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Affiliation(s)
- Zhen Ma
- Lanzhou University Second Hospital, Lanzhou 730030, China; Department of Surgical Oncology, Lanzhou University Second Hospital, Lanzhou 730030, China; Key Laboratory of the Digestive System tumours of Gansu Province
| | - Junge Deng
- Lanzhou University Second Hospital, Lanzhou 730030, China; Department of Surgical Oncology, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Bin Ma
- Lanzhou University Second Hospital, Lanzhou 730030, China; Department of Surgical Oncology, Lanzhou University Second Hospital, Lanzhou 730030, China; Key Laboratory of the Digestive System tumours of Gansu Province
| | - Hao Chen
- Lanzhou University Second Hospital, Lanzhou 730030, China; Department of Surgical Oncology, Lanzhou University Second Hospital, Lanzhou 730030, China; Key Laboratory of the Digestive System tumours of Gansu Province.
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Larsen PO, Nerup N, Andersen J, Dohrn N, Klein MF, Brisling S, Salomon S, Andersen PV, Möller S, Svendsen MBS, Rahr HB, Iversen LH, Gögenur I, Qvist N, Ellebaek MB. Anastomotic perfusion assessment with indocyanine green in robot-assisted low-anterior resection, a multicenter study of interobserver variation. Surg Endosc 2023; 37:3602-3609. [PMID: 36624218 PMCID: PMC10156761 DOI: 10.1007/s00464-022-09819-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/05/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Securing sufficient blood perfusion to the anastomotic area after low-anterior resection is a crucial factor in preventing anastomotic leakage (AL). Intra-operative indocyanine green fluorescent imaging (ICG-FI) has been suggested as a tool to assess perfusion. However, knowledge of inter-observer variation among surgeons in the interpretation of ICG-FI is sparse. Our primary objective was to evaluate inter-observer variation among surgeons in the interpretation of bowel blood-perfusion assessed visually by ICG-FI. Our secondary objective was to compare the results both from the visual assessment of ICG and from computer-based quantitative analyses of ICG-FI between patients with and without the development of AL. METHOD A multicenter study, including patients undergoing robot-assisted low anterior resection with stapled anastomosis. ICG-FI was evaluated visually by the surgeon intra-operatively. Postoperatively, recorded videos were anonymized and exchanged between centers for inter-observer evaluation. Time to visibility (TTV), time to maximum visibility (TMV), and time to wash-out (TWO) were visually assessed. In addition, the ICG-FI video-recordings were analyzed using validated pixel analysis software to quantify blood perfusion. RESULTS Fifty-five patients were included, and five developed clinical AL. Bland-Altman plots (BA plots) demonstrated wide inter-observer variation for visually assessed fluorescence on all parameters (TTV, TMV, and TWO). Comparing leak-group with no-leak group, we found no significant differences for TTV: Hazard Ratio; HR = 0.82 (CI 0.32; 2.08), TMV: HR = 0.62 (CI 0.24; 1.59), or TWO: HR = 1.11 (CI 0.40; 3.11). In the quantitative pixel analysis, a lower slope of the fluorescence time-curve was found in patients with a subsequent leak: median 0.08 (0.07;0.10) compared with non-leak patients: median 0.13 (0.10;0.17) (p = 0.04). CONCLUSION The surgeon's visual assessment of the ICG-FI demonstrated wide inter-observer variation, there were no differences between patients with and without AL. However, quantitative pixel analysis showed a significant difference between groups. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04766060.
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Affiliation(s)
- Pernille O Larsen
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
- Surgical Department, Colorectal Cancer Center South, Vejle Hospital, University Hospital of Southern Denmark, Beridderbakken 4, 7100, Vejle, Denmark.
- Open Patient Data Explorative Network, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Nikolaj Nerup
- Department of Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jesper Andersen
- Surgical Department, Colorectal Cancer Center South, Vejle Hospital, University Hospital of Southern Denmark, Beridderbakken 4, 7100, Vejle, Denmark
| | - Niclas Dohrn
- Department of Surgery, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Mads Falk Klein
- Department of Surgery, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Steffen Brisling
- Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark
| | - Soren Salomon
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Per V Andersen
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Soren Möller
- Open Patient Data Explorative Network, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Morten B S Svendsen
- CAMES Engineering, Copenhagen Academy of Medical Education and Simulation, Capital Region of Denmark, Copenhagen, Denmark
| | - Hans B Rahr
- Surgical Department, Colorectal Cancer Center South, Vejle Hospital, University Hospital of Southern Denmark, Beridderbakken 4, 7100, Vejle, Denmark
| | - Lene H Iversen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Ismail Gögenur
- Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark
| | - Niels Qvist
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Mark B Ellebaek
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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10
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Bedzhanyan AL, Petrenko KN, Sumbaev AA, Frolova YV, Nikoda VV, Butenko AV. [ICG angiography in prevention of colorectal anastomotic leakage]. Khirurgiia (Mosk) 2023:25-32. [PMID: 37682544 DOI: 10.17116/hirurgia202309225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of indocyanine green fluorescence angiography in assessment of colorectal anastomosis perfusion. MATERIAL AND METHODS A prospective single-center non-randomized comparative study included 85 patients with rectum and sigmoid colon cancer between September 2019 and March 2023. In the main group (n=41), we intraoperatively injected indocyanine green (ICG) IV to assess perfusion in the near infrared spectrum. In the control group (n=44), the same interventions were performed without ICG. RESULTS In the main group, anterior resection of the rectum was performed in 23 (56.1%) patients with neoplasms of distal sigmoid colon and rectosigmoid tumors. Low anterior resection was performed in 18 (43.9%) cases. In the control group, the same procedures were carried out in 24 (54.5%) and 20 (45.5%) patients, respectively. After mobilization of the colon and ICG injection, we corrected resection line in 4 cases. As soon as anastomosis was formed and blood supply was controlled by ICG fluorescence angiography, we performed a water-bubble test to detect anastomotic leakage. Positive tests were detected in 4 (9.8%) and 5 (11.4%) patients of both groups, respectively. Postoperative complications occurred in 10 (24.4%) and 11 (27.3%) patients, respectively (p=0.94). Anastomosis failure was found in 1 and 7 patients, respectively. Anastomotic leakage grade «B» was significantly more common in the control group (2.4 and 13.6%, respectively, p=0.06). Anastomotic leaks were absent in all 4 patients who underwent resection level adjustment after intraoperative ICG angiography. CONCLUSION Fluorescent luminescence will qualitatively improve intraoperative diagnosis of hypoperfusion of resection edges. Undoubtedly, this will reduce the incidence of colorectal anastomotic leaks caused by ischemia of large bowel wall.
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Affiliation(s)
- A L Bedzhanyan
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - K N Petrenko
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - A A Sumbaev
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - Yu V Frolova
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - V V Nikoda
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - A V Butenko
- Petrovsky National Research Center of Surgery, Moscow, Russia
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11
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Gaidarski III AA, Ferrara M. The Colorectal Anastomosis: A Timeless Challenge. Clin Colon Rectal Surg 2022; 36:11-28. [PMID: 36619283 PMCID: PMC9815911 DOI: 10.1055/s-0042-1756510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Colorectal anastomosis is a sophisticated problem that demands an elaborate discussion and an elegant solution. "Those who forget the past are condemned to repeat it." George Santayana, Life of Reason , 1905.
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Affiliation(s)
| | - Marco Ferrara
- Colon and Rectal Clinic of Orlando, Orlando, Florida,Address for correspondence Marco Ferrara, MD Colon and Rectal Clinic of Orlando110 West Underwood ST, Suite A, Orlando, FL 32806
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12
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Khosrawipour T, Li S, Steward E, Chaudhry H, Nguyen D, Khosrawipour V, Jafari MD, Pigazzi A. Assessment of Anastomotic Viability With Spectroscopic Real-time Oxygen Saturation Measurement in a Porcine Study. Surg Innov 2022:15533506221127378. [PMID: 36255230 DOI: 10.1177/15533506221127378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Anastomotic leakage (AL) is a severe complication following intestinal procedures. Intra.Ox™ by ViOptix Inc (Newark, CA, USA) is a novel, FDA-approved spectroscopic device which enables real-time measurement of mixed tissue oxygen saturation (StO2). Using a porcine model, this study explores the correlation between StO2 measurements and AL formation as well as investigates the applicability of Intra.Ox™ in the clinical setting. METHODS Eleven female swine were divided into 3 groups to explore AL formation in different ischemic conditions. Group 1: 100% mesenteric-vascular ligation, n = 3; Group 2: 50% ligation, n = 5; Group 3: No mesenteric ligation, n = 3. StO2 at the anastomotic line was measured before and after vessel ligation and anastomosis. Measurements were taken at 6 distinct locations along afferent and efferent loops. AL was evaluated on postoperative day 5 by re-laparotomy. RESULTS AL rate was 100%, 60% and 0% in groups 1, 2 and 3, respectively. Post-anastomotic StO2 in group 1 (22.9 ± 18.5%) and 2 (39.2 ± 20.1%) were significantly lower than in group 3 (53.1 ± 8.3%, p<.0001). Post-anastomotic StO2 readings ≤40% indicated AL potential with 100% sensitivity,+ 80% specificity, positive predictive value of 85.7% and negative predictive value of 100%. CONCLUSION This study demonstrates the value of Intra.Ox™ in assessing local perfusion and indicate the association between low StO2 and AL by providing accurate, real-time, noninvasive tissue oxygenation measurements at anastomotic sites. Further studies are required to investigate the clinical application of this novel device in intestinal surgery.
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Affiliation(s)
- Tanja Khosrawipour
- Division of Colorectal Surgery, Department of Surgery, 21769University of California Irvine, Orange, CA, USA.,Department of Surgery (A), University-Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Germany
| | - Shiri Li
- Division of Colorectal Surgery, Department of Surgery, 21769University of California Irvine, Orange, CA, USA.,Division of Colon and Rectal Surgery, Department of Surgery, 159947New York Presbyterian Hospital- Weill Cornell College of Medicine, New York, NY, USA
| | - Earl Steward
- Division of Colorectal Surgery, Department of Surgery, 21769University of California Irvine, Orange, CA, USA
| | - Haris Chaudhry
- Division of Colorectal Surgery, Department of Surgery, 21769University of California Irvine, Orange, CA, USA
| | - Danielle Nguyen
- Division of Colorectal Surgery, Department of Surgery, 21769University of California Irvine, Orange, CA, USA
| | - Veria Khosrawipour
- Division of Colorectal Surgery, Department of Surgery, 21769University of California Irvine, Orange, CA, USA
| | - Mehraneh Dorna Jafari
- Division of Colorectal Surgery, Department of Surgery, 21769University of California Irvine, Orange, CA, USA
| | - Alessio Pigazzi
- Division of Colorectal Surgery, Department of Surgery, 21769University of California Irvine, Orange, CA, USA.,Division of Colon and Rectal Surgery, Department of Surgery, 159947New York Presbyterian Hospital- Weill Cornell College of Medicine, New York, NY, USA
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13
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Lopes EW, Lochhead P, Burke KE, Richter JM, Ananthakrishnan AN, Chan AT, Khalili H. Risk Factors for Incident Inflammatory Bowel Disease According to Disease Phenotype. Clin Gastroenterol Hepatol 2022; 20:2347-2357.e14. [PMID: 35031525 PMCID: PMC9850926 DOI: 10.1016/j.cgh.2022.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/22/2021] [Accepted: 01/02/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We examined whether relationships between known risk factors for Crohn's disease (CD) and ulcerative colitis (UC) differ according to disease phenotype, defined by Montreal classification, at the time of diagnosis. METHODS We performed a prospective cohort study of 208,070 adults from the Nurses' Health Study (NHS), NHSII, and Health Professionals Follow-Up Study (HPFS). Dietary, lifestyle, and medical data were obtained at baseline and every 2-4 years. We confirmed cases of inflammatory bowel disease (IBD) and their phenotypes via medical record review. We tested for heterogeneity across CD subtypes using the likelihood ratio test and for linear heterogeneity across UC subtypes using the meta-regression method. RESULTS We ascertained 346 cases of CD and 456 cases of UC over 5,117,021 person-years of follow-up (1986-2016 for NHS and HPFS; 1991-2017 for NHSII). Fiber intake was associated with decreased risk for ileocolonic but not ileal or colonic CD (Pheterogeneity = .04). Physical activity was associated with decreased risk of nonstricturing and nonpenetrating CD but not of penetrating CD (Pheterogeneity = .02). Higher body mass index and current smoking were associated with decreased risk of proctitis and left-sided UC but not of pan-UC (Plinear heterogeneity= .004 and .02, respectively). The associations between other risk factors examined and risk of CD and UC did not differ by disease phenotype (all Pheterogeneity > .06). CONCLUSIONS In 3 large prospective cohorts, we observed that dietary and lifestyle risk factors for IBD may differ according to disease phenotype. These findings highlight the need for disease stratification in future epidemiologic studies.
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Affiliation(s)
- Emily W Lopes
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; Clinical and Translation Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Paul Lochhead
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kristin E Burke
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - James M Richter
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; Clinical and Translation Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andrew T Chan
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; Clinical and Translation Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; Clinical and Translation Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts.
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14
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Zheng H, Li F, Xie X, Zhao S, Huang B, Tong W. Preservation versus nonpreservation of the left colic artery in anterior resection for rectal cancer: a propensity score-matched analysis. BMC Surg 2022; 22:164. [PMID: 35538516 PMCID: PMC9092824 DOI: 10.1186/s12893-022-01614-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/18/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Preserving the left colic artery (LCA) during anterior resection for rectal cancer is controversial, and robust evidence of the outcomes of LCA preservation plus apical lymph node dissection is lacking. The purpose of this study was to investigate the impact of LCA preservation plus apical lymph node dissection surgery on anastomotic leakage and number of harvested lymph nodes. METHODS Patients who underwent laparoscopic or robotic anterior resection for rectal cancer between September 2017 and May 2020 were retrospectively assessed. The patients were categorized into two groups: preservation of LCA and nonpreservation of LCA. A one-to-one propensity score-matched analysis was performed to decrease confounding. The primary outcome was anastomotic leakage within 30 days after surgery. The secondary outcomes were number of harvested lymph nodes, 3-year overall survival, and 3-year disease-free survival. RESULTS A total of 216 patients were eligible for this study, and propensity score matching yielded 60 patients in each group. Anastomotic leakage in the LCA preservation group was significantly lower than that in the LCA nonpreservation group (3.3% vs. 13.3%, P = 0.048). No significant differences were observed in blood loss, operation time, intraoperative complications, splenic flexure mobilization, total number of harvested lymph nodes, number of positive lymph nodes, time to first flatus, or postoperative hospital stay. Kaplan-Meier survival analysis showed a 3-year disease-free survival of 85.7% vs. 80.5% (P = 0.738) and overall survival of 92.4% vs. 93.7% (P = 0.323) for the preservation and nonpreservation groups, respectively. CONCLUSION LCA preservation plus apical lymph node dissection surgery for rectal cancer may help reduce the incidence of anastomotic leakage without impairing the number of harvested lymph nodes. Preliminary results suggest that 3-year disease-free survival and overall survival rates may not differ between the two types of surgery, but studies with larger sample sizes are needed to confirm these conclusions. Trial registration ClinicalTrials.gov, NCT03776370. Registered 14 December 2018-Retrospectively registered, https://clinicaltrials.gov .
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Affiliation(s)
- Huichao Zheng
- Department of General Surgery, Daping Hospital, Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, 400042, China
| | - Fan Li
- Department of General Surgery, Daping Hospital, Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, 400042, China
| | - Xingjie Xie
- Department of General Surgery, Daping Hospital, Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, 400042, China
| | - Song Zhao
- Department of General Surgery, Daping Hospital, Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, 400042, China
| | - Bin Huang
- Department of General Surgery, Daping Hospital, Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, 400042, China
| | - Weidong Tong
- Department of General Surgery, Daping Hospital, Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, 400042, China.
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15
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Khetan VU, Muderspach LI, Miller HA, Licon E, Adams CL, Brunette LL, Pham HQ, Yessaian AA, Roman LD, Matsuo K, Ciccone MA. Side-to-end reanastomosis after low-anterior resection (STELAR): Outcomes, feasibility, and description of procedure performed by a gynecologic oncology service. J Surg Oncol 2022; 126:563-570. [PMID: 35476891 DOI: 10.1002/jso.26907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/02/2022] [Accepted: 04/13/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Low anterior rectosigmoid resection for a gynecologic disease is usually performed in concert with other procedures and can result in significant morbidity should anastomotic complication occur. This study examined surgical outcomes of side-to-end reanastomosis after low anterior resection (STELAR) performed by gynecologic oncology service. METHODS This is a case series examining consecutive patients who underwent STELAR for gynecologic indications by a single gynecologic oncology group from 2009 to 2018. Prospectively collected institutional surgical database was searched for STELAR, and standard descriptive statistics were used to describe intraoperative and postoperative complications specific to reanastomosis. RESULTS A total of 69 women underwent STELAR, with median age and body mass index of 54 years and 24 kg/m2 , respectively. 63.8% of patients had ovarian cancer and 84.4% had stage III-IV disease. The median estimated blood loss was 875 ml. Four (5.8%) women underwent protective loop colostomy at the time of STELAR. Postoperatively, there was 1 (1.4%) case of abscess formation within 30 days and 1 (1.4%) case of anastomotic leak 5 weeks after STELAR that required reoperation and diversion. No cases of fistula were clinically identified. CONCLUSION Side-to-end reanastomosis may be a safe and feasible procedure to accomplish low rectosigmoid anastomosis in women with gynecologic disease.
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Affiliation(s)
- Varun U Khetan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Laila I Muderspach
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Heather A Miller
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Ernesto Licon
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Crystal L Adams
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Laurie L Brunette
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Huyen Q Pham
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Annie A Yessaian
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Marcia A Ciccone
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
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Ahmed T, Pai M, Mallik E, Varghese G, Ashish S, Acharya A, Krishna A. Applications of indocyanine green in surgery: A single center case series. Ann Med Surg (Lond) 2022; 77:103602. [PMID: 35637998 PMCID: PMC9142393 DOI: 10.1016/j.amsu.2022.103602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/26/2022] Open
Abstract
Background Fluorescence imaging using indocyanine green (ICG) has revolutionized commonly performed general surgical procedures by providing superior anatomic imaging and enhancing safety for patients. ICG, when injected, shows a bright green fluorescence when subjected to the near infra-red (NIR) spectrum. Materials and methods We employed the use of ICG in Laparoscopic cholecystectomy, Intestinal Colorectal Anastomosis and Hernia to assess vascularity of resected ends and bowel viability, Sentinel Lymph node mapping, Vascular surgery to assess amputation stump success and in assessing Flap Vascularity and healing. Results ICG when administered had successfully shown bright green fluorescence in different cases thereby aiding in surgical procedures. Conclusion Routine intraoperative use of ICG could pave the way for a more objective assessment of different surgical circumstances and thereby reduce personalized barriers to aciurgy. ICG fluorescence therefore seems to be a promising apparatus in standard general surgical procedures minimizing untoward errors and improving patient conformance.
Fluorescence guided surgery, due to its enhanced visualization ability, has assisted surgeons in minimizing errors. Indocyanine green (ICG) is the only fluorophore to be used in humans and has a wide margin of safety. ICG shows a bright green fluorescence when subjected to near infra-red spectrum. Fluorescence imaging using ICG is a valuable accompaniment to open and laparoscopic surgery. Routine use of ICG provides better visual assessment which helps in decision making, thereby improving patient outcome.
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Meijer RPJ, Faber RA, Bijlstra OD, Braak JPBM, Meershoek-Klein Kranenbarg E, Putter H, Mieog JSD, Burggraaf K, Vahrmeijer AL, Hilling DE. AVOID; a phase III, randomised controlled trial using indocyanine green for the prevention of anastomotic leakage in colorectal surgery. BMJ Open 2022; 12:e051144. [PMID: 35365509 PMCID: PMC8977759 DOI: 10.1136/bmjopen-2021-051144] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Anastomotic leakage (AL) is one of the major complications after colorectal surgery. Compromised tissue perfusion at the anastomosis site increases the risk of AL. Several cohort studies have shown that indocyanine green (ICG) combined with fluorescent near-infrared imaging is a feasible and reproducible technique for real-time intraoperative imaging of tissue perfusion, leading to reduced leakage rates after colorectal resection. Unfortunately, these studies were not randomised. Therefore, we propose a randomised controlled trial to assess the value of ICG-guided surgery in reducing AL after colorectal surgery. METHODS AND ANALYSIS A multicentre, randomised controlled clinical trial will be conducted to assess the benefit of ICG-guided surgery in preventing AL. A total of 978 patients scheduled for colorectal surgery will be included. Patients will be randomised between the Fluorescence Guided Bowel Anastomosis group and the Conventional Bowel Anastomosis group. The primary endpoint is clinically relevant AL (defined as requiring active therapeutic intervention or reoperation) within 90 days after surgery. Among the secondary endpoints are 30-day clinically relevant AL, all-cause postoperative complications, all-cause and AL-related mortality, surgical and non-surgical reinterventions, total surgical time, length of hospital stay and all-cause and AL-related readmittance. ETHICS AND DISSEMINATION This protocol has been approved by the Medical Ethical Committee Leiden-Den Haag-Delft (METC-LDD) and is registered at ClinicalTrials.gov and trialregister.nl. The results of this study will be reported through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT04712032; NL7502.
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Affiliation(s)
- Ruben P J Meijer
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
- Centre for Human Drug Research, Leiden, South Holland, Netherlands
| | - Robin A Faber
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Okker D Bijlstra
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Jeffrey P B M Braak
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | | | - Hein Putter
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - J Sven D Mieog
- Surgery, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Koos Burggraaf
- Centre for Human Drug Research, Leiden, South Holland, Netherlands
| | | | - Denise E Hilling
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
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Constructing a sound anastomosis. SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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19
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Multisensor perfusion assessment cohort study: Preliminary evidence toward a standardized assessment of indocyanine green fluorescence in colorectal surgery. Surgery 2022; 172:69-73. [DOI: 10.1016/j.surg.2021.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 12/22/2022]
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21
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Ntentakis DP, Ntentaki AM, Delavogia E, Kalomoiris L, Venieri D, Arkadopoulos N, Kalogerakis N. Dissolved oxygen technologies as a novel strategy for non-healing wounds: A critical review. Wound Repair Regen 2021; 29:1062-1079. [PMID: 34655455 DOI: 10.1111/wrr.12972] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/14/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023]
Abstract
Non-healing wounds are steadily becoming a global-health issue. Prolonged hypoxia propagates wound chronicity; yet, oxygenating treatments are considered inadequate to date. Dissolved oxygen (DO) in aqueous solutions introduces a novel approach to enhanced wound oxygenation, and is robustly evaluated for clinical applications. A systematic literature search was conducted, whereby experimental and clinical studies of DO technologies were categorized per engineering approach. Technical principles, methodology, endpoints and outcomes were analysed for both oxygenating and healing effects. Forty articles meeting our inclusion criteria were grouped as follows: DO solutions (17), oxygen (O2 ) dressings (9), O2 hydrogels (11) and O2 emulsions (3). All technologies improved wound oxygenation, each to a variable degree. They also achieved at least one statistically significant outcome related to wound healing, mainly in epithelialization, angiogenesis and collagen synthesis. Scarcity in clinical data and methodological variability precluded quantitative comparisons among the biotechnologies studied. DO technologies warrantee further evaluation for wound oxygenation in the clinical setting. Standardised methodologies and targeted research questions are pivotal to facilitate global integration in healthcare.
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Affiliation(s)
- Dimitrios P Ntentakis
- School of Chemical and Environmental Engineering, Technical University of Crete, Chania, Greece
| | | | - Eleni Delavogia
- Department of Paediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Loukas Kalomoiris
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Danae Venieri
- School of Chemical and Environmental Engineering, Technical University of Crete, Chania, Greece
| | - Nikolaos Arkadopoulos
- Fourth Department of Surgery, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicolas Kalogerakis
- School of Chemical and Environmental Engineering, Technical University of Crete, Chania, Greece
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22
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Bobel MC, Altman A, Gaertner WB. Immunofluorescence in Robotic Colon and Rectal Surgery. Clin Colon Rectal Surg 2021; 34:338-344. [PMID: 34504405 DOI: 10.1055/s-0041-1729866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The indocyanine green fluorescence imaging system is a surgical tool with increasing applications in colon and rectal surgery that has received growing acceptance in various surgical disciplines as a potentially valid method to enhance surgical field visualization, improve lymph node retrieval, and decrease anastomotic leak. Small noncomparative prospective trials have shown that intraoperative fluorescence imaging is a safe and feasible method to assess anastomotic perfusion and that its use may impact anastomotic leak rates. However, larger prospective and randomized studies are required to validate its role and impact in colorectal surgery. The purpose of this article is to review the current status of the use of immunofluorescence in colon and rectal surgery, as well as new applications in robotic colon and rectal resections.
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Affiliation(s)
- Matthew C Bobel
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Ariella Altman
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Wolfgang B Gaertner
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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23
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Benčurik V, Škrovina M, Martínek L, Bartoš J, Macháčková M, Dosoudil M, Štěpánová E, Přibylová L, Briš R, Vomáčková K. Intraoperative fluorescence angiography and risk factors of anastomotic leakage in mini-invasive low rectal resections. Surg Endosc 2021; 35:5015-5023. [PMID: 32970211 DOI: 10.1007/s00464-020-07982-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND One of the prerequisites for proper healing of the anastomosis after a colorectal resection is adequate blood supply to the connected intestinal segments. It has been proposed that adequate visualization of the blood flow using indocyanine green (ICG) could lead to the reduction in the incidence of anastomotic leakage (AL). The aim of this study was to assess the effectiveness of intraoperative fluorescence angiography (FA) in decreasing the incidence of AL after minimally invasive low anterior resection (LAR) with total mesorectal excision (TME) in rectal cancer patients and to determine predictors of anastomotic leak. METHODS From August 2015 to January 2019, data from 100 patients who underwent mini-invasive TME for rectal cancer using FA with indocyanine green (ICG) were prospectively collected and analyzed. They were compared with retrospectively analyzed data from a historical control group operated by one team of surgeons before the introduction of FA from November 2012 to August 2015 (100 patients). All patients from both groups were operated sequentially in one oncological center in Nový Jičín. RESULTS The incidence of AL was significantly lower in the ICG group (19% vs. 9%, p = 0.042, χ2 test). In fifteen patients in the ICG group (15%), the resection line was moved due to insufficient perfusion. Using Pearson's χ2 test, diabetes (p = 0.036) and application of a transanal drain (NoCoil) (p = 0.032) were identified as other risk factors (RFs) for AL. CONCLUSION The use of ICG to visualize tissue perfusion in low rectal resections for cancer can lead to a reduction of AL.
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Affiliation(s)
- Vladimír Benčurik
- Department of Surgery, Hospital Novy Jicin, Purkyňova 2138/16, Novy Jicin, 74101, Czech Republic.
- AGEL Research and Training Institute, Prostejov, Czech Republic.
| | - Matej Škrovina
- Department of Surgery, Hospital Novy Jicin, Purkyňova 2138/16, Novy Jicin, 74101, Czech Republic
- Department of Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
- AGEL Research and Training Institute, Prostejov, Czech Republic
| | - Lubomír Martínek
- Department of Surgery, Hospital Novy Jicin, Purkyňova 2138/16, Novy Jicin, 74101, Czech Republic
- Department of Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Jiří Bartoš
- Department of Surgery, Hospital Novy Jicin, Purkyňova 2138/16, Novy Jicin, 74101, Czech Republic
| | - Mária Macháčková
- Department of Surgery, Hospital Novy Jicin, Purkyňova 2138/16, Novy Jicin, 74101, Czech Republic
| | - Michal Dosoudil
- Department of Surgery, Hospital Novy Jicin, Purkyňova 2138/16, Novy Jicin, 74101, Czech Republic
| | - Erika Štěpánová
- Department of Surgery, Hospital Novy Jicin, Purkyňova 2138/16, Novy Jicin, 74101, Czech Republic
| | - Lenka Přibylová
- Department of Applied Mathematics, Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, Ostrava, Czech Republic
| | - Radim Briš
- Department of Applied Mathematics, Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, Ostrava, Czech Republic
| | - Katherine Vomáčková
- Department of Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
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24
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Zocola E, Meyer J, Christou N, Liot E, Toso C, Buchs NC, Ris F. Role of near-infrared fluorescence in colorectal surgery. World J Gastroenterol 2021; 27:5189-5200. [PMID: 34497444 PMCID: PMC8384744 DOI: 10.3748/wjg.v27.i31.5189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/27/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
Near-infrared fluorescence (NIRF) is a technique of augmented reality that, when applied in the operating theatre, allows the colorectal surgeon to visualize and assess bowel vascularization, to identify lymph nodes draining a cancer site and to identify ureters. Herein, we review the literature regarding NIRF in colorectal surgery.
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Affiliation(s)
- Elodie Zocola
- Medical School, University of Geneva, Genève 1205, Switzerland
| | - Jeremy Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1205, Switzerland
| | - Niki Christou
- Service de Chirurgie Digestive, Endocrinienne et Générale, CHU de Limoges, Limoges Cedex 87025, France
| | - Emilie Liot
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1205, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1205, Switzerland
| | | | - Frédéric Ris
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1205, Switzerland
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25
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Marland JRK, Gray ME, Argyle DJ, Underwood I, Murray AF, Potter MA. Post-Operative Monitoring of Intestinal Tissue Oxygenation Using an Implantable Microfabricated Oxygen Sensor. MICROMACHINES 2021; 12:810. [PMID: 34357220 PMCID: PMC8303214 DOI: 10.3390/mi12070810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 12/02/2022]
Abstract
Anastomotic leakage (AL) is a common and dangerous post-operative complication following intestinal resection, causing substantial morbidity and mortality. Ischaemia in the tissue surrounding the anastomosis is a major risk-factor for AL development. Continuous tissue oxygenation monitoring during the post-operative recovery period would provide early and accurate early identification of AL risk. We describe the construction and testing of a miniature implantable electrochemical oxygen sensor that addresses this need. It consisted of an array of platinum microelectrodes, microfabricated on a silicon substrate, with a poly(2-hydroxyethyl methacrylate) hydrogel membrane to protect the sensor surface. The sensor was encapsulated in a biocompatible package with a wired connection to external instrumentation. It gave a sensitive and highly linear response to variations in oxygen partial pressure in vitro, although over time its sensitivity was partially decreased by protein biofouling. Using a pre-clinical in vivo pig model, acute intestinal ischaemia was robustly and accurately detected by the sensor. Graded changes in tissue oxygenation were also measurable, with relative differences detected more accurately than absolute differences. Finally, we demonstrated its suitability for continuous monitoring of tissue oxygenation at a colorectal anastomosis over a period of at least 45 h. This study provides evidence to support the development and use of implantable electrochemical oxygen sensors for post-operative monitoring of anastomosis oxygenation.
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Affiliation(s)
- Jamie R. K. Marland
- School of Engineering, Institute for Integrated Micro and Nano Systems, University of Edinburgh, Scottish Microelectronics Centre, King’s Buildings, Edinburgh EH9 3FF, UK;
| | - Mark E. Gray
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Easter Bush, Roslin, Midlothian EH25 9RG, UK; (M.E.G.); (D.J.A.)
| | - David J. Argyle
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Easter Bush, Roslin, Midlothian EH25 9RG, UK; (M.E.G.); (D.J.A.)
| | - Ian Underwood
- School of Engineering, Institute for Integrated Micro and Nano Systems, University of Edinburgh, Scottish Microelectronics Centre, King’s Buildings, Edinburgh EH9 3FF, UK;
| | - Alan F. Murray
- School of Engineering, Institute for Bioengineering, University of Edinburgh, Faraday Building, Edinburgh EH9 3DW, UK;
| | - Mark A. Potter
- Department of Surgery, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK;
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26
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Gray M, Marland JRK, Murray AF, Argyle DJ, Potter MA. Predictive and Diagnostic Biomarkers of Anastomotic Leakage: A Precision Medicine Approach for Colorectal Cancer Patients. J Pers Med 2021; 11:471. [PMID: 34070593 PMCID: PMC8229046 DOI: 10.3390/jpm11060471] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
Development of an anastomotic leak (AL) following intestinal surgery for the treatment of colorectal cancers is a life-threatening complication. Failure of the anastomosis to heal correctly can lead to contamination of the abdomen with intestinal contents and the development of peritonitis. The additional care that these patients require is associated with longer hospitalisation stays and increased economic costs. Patients also have higher morbidity and mortality rates and poorer oncological prognosis. Unfortunately, current practices for AL diagnosis are non-specific, which may delay diagnosis and have a negative impact on patient outcome. To overcome these issues, research is continuing to identify AL diagnostic or predictive biomarkers. In this review, we highlight promising candidate biomarkers including ischaemic metabolites, inflammatory markers and bacteria. Although research has focused on the use of blood or peritoneal fluid samples, we describe the use of implantable medical devices that have been designed to measure biomarkers in peri-anastomotic tissue. Biomarkers that can be used in conjunction with clinical status, routine haematological and biochemical analysis and imaging have the potential to help to deliver a precision medicine package that could significantly enhance a patient's post-operative care and improve outcomes. Although no AL biomarker has yet been validated in large-scale clinical trials, there is confidence that personalised medicine, through biomarker analysis, could be realised for colorectal cancer intestinal resection and anastomosis patients in the years to come.
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Affiliation(s)
- Mark Gray
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Easter Bush, Roslin, Midlothian, Edinburgh EH25 9RG, UK;
| | - Jamie R. K. Marland
- School of Engineering, Institute for Integrated Micro and Nano Systems, University of Edinburgh, Scottish Microelectronics Centre, King’s Buildings, Edinburgh EH9 3FF, UK;
| | - Alan F. Murray
- School of Engineering, Institute for Bioengineering, University of Edinburgh, Faraday Building, The King’s Buildings, Edinburgh EH9 3DW, UK;
| | - David J. Argyle
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Easter Bush, Roslin, Midlothian, Edinburgh EH25 9RG, UK;
| | - Mark A. Potter
- Department of Surgery, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK;
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27
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Strowitzki MJ, Kimmer G, Wehrmann J, Ritter AS, Radhakrishnan P, Opitz VM, Tuffs C, Biller M, Kugler J, Keppler U, Harnoss JM, Klose J, Schmidt T, Blanco A, Taylor CT, Schneider M. Inhibition of HIF-prolyl hydroxylases improves healing of intestinal anastomoses. JCI Insight 2021; 6:139191. [PMID: 33784253 PMCID: PMC8119215 DOI: 10.1172/jci.insight.139191] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 03/24/2021] [Indexed: 12/15/2022] Open
Abstract
Anastomotic leakage (AL) accounts for a major part of in-house mortality in patients undergoing colorectal surgery. Local ischemia and abdominal sepsis are common risk factors contributing to AL and are characterized by upregulation of the hypoxia-inducible factor (HIF) pathway. The HIF pathway is critically regulated by HIF-prolyl hydroxylases (PHDs). Here, we investigated the significance of PHDs and the effects of pharmacologic PHD inhibition (PHI) during anastomotic healing. Ischemic or septic colonic anastomoses were created in mice by ligation of mesenteric vessels or lipopolysaccharide-induced abdominal sepsis, respectively. Genetic PHD deficiency (Phd1-/-, Phd2+/-, and Phd3-/-) or PHI were applied to manipulate PHD activity. Pharmacologic PHI and genetic PHD2 haplodeficiency (Phd2+/-) significantly improved healing of ischemic or septic colonic anastomoses, as indicated by increased bursting pressure and reduced AL rates. Only Phd2+/- (but not PHI or Phd1-/-) protected from sepsis-related mortality. Mechanistically, PHI and Phd2+/- induced immunomodulatory (M2) polarization of macrophages, resulting in increased collagen content and attenuated inflammation-driven immune cell recruitment. We conclude that PHI improves healing of colonic anastomoses in ischemic or septic conditions by Phd2+/--mediated M2 polarization of macrophages, conferring a favorable microenvironment for anastomotic healing. Patients with critically perfused colorectal anastomosis or abdominal sepsis could benefit from pharmacologic PHI.
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Affiliation(s)
- Moritz J Strowitzki
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany.,School of Medicine and Conway Institute of Biomolecular & Biomedical Research, University College Dublin, Dublin, Ireland
| | - Gwendolyn Kimmer
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Julian Wehrmann
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Alina S Ritter
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Praveen Radhakrishnan
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Vanessa M Opitz
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Christopher Tuffs
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Marvin Biller
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Julia Kugler
- School of Medicine and Conway Institute of Biomolecular & Biomedical Research, University College Dublin, Dublin, Ireland
| | - Ulrich Keppler
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany.,Department of Anaesthesiology, Heidelberg University, Heidelberg, Germany
| | - Jonathan M Harnoss
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Johannes Klose
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Thomas Schmidt
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Alfonso Blanco
- Flow Cytometry Core Technology. Conway Institute of Biomolecular & Biomedical Research, University College Dublin, Dublin, Ireland
| | - Cormac T Taylor
- School of Medicine and Conway Institute of Biomolecular & Biomedical Research, University College Dublin, Dublin, Ireland
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
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28
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Aiba T, Uehara K, Ogura A, Tanaka A, Yonekawa Y, Hattori N, Nakayama G, Kodera Y, Ebata T, Nagino M. The significance of the time to arterial perfusion in intraoperative ICG angiography during colorectal surgery. Surg Endosc 2021; 35:7227-7235. [PMID: 33398555 DOI: 10.1007/s00464-020-08185-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/17/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intraoperative indocyanine green angiography (ICG-A) is a promising tool to confirm blood supply; however, the assessment is difficult without clear demarcation. In this study, the clinical impact of the time to arterial perfusion (TAP) on anastomotic leakage (AL) was evaluated, especially in patients without ICG demarcation. METHODS The TAP was assessed using ICG-A during colorectal surgery in 110 patients. ICG demarcation required changing the transection line, and the TAP was measured at the new stump. The patients were divided into marginal flow (MF) and direct flow (DF) groups according to the arterial route. Delayed TAP was defined as the third quartile or slower TAP in each group. RESULTS Sixty-six patients (60%) were classified into the MF group, including 64 patients who underwent rectal or sigmoid resection with high ligation of the inferior mesenteric artery. The cut-off value of the delayed TAP in the MF group was significantly slower than that in the DF group (30 and 22 s, respectively, p < 0.001). In the entire cohort, the transection line was changed in 2 patients, resulting in no AL. Nevertheless, AL still developed in 6 patients (5.4%), 5 of whom were in the MF group, and delayed TAP was found in 5 of 6 patients. Delayed TAP was significantly associated with AL in the MF group (p = 0.046). CONCLUSIONS In patients without ICG demarcation, delayed TAP might be helpful for predicting the high-risk patients with AL in the MF group; however, performing diverting stoma or strictly careful observation might be a realistic reaction.
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Affiliation(s)
- Toshisada Aiba
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Kay Uehara
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan.
| | - Atsushi Ogura
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Aya Tanaka
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Yoshihiko Yonekawa
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Norifumi Hattori
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Goro Nakayama
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
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29
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Amagai H, Miyauchi H, Muto Y, Uesato M, Ohira G, Imanishi S, Maruyama T, Tochigi T, Okada K, Maruyama M, Matsubara H. Clinical utility of transanal indocyanine green near-infrared fluorescence imaging for evaluation of colorectal anastomotic perfusion. Surg Endosc 2020; 34:5283-5293. [PMID: 31820154 DOI: 10.1007/s00464-019-07315-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 12/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although indocyanine green (ICG) fluorescence imaging has been reported to be useful for assessing colorectal perfusion, unstable quantification remains an issue. We performed ICG fluorescence observation from the luminal side and examined the usefulness of the transanal approach. METHODS A total of 69 patients who underwent left-side colon surgery were enrolled in this cohort study. After the anastomosis had been constructed, ICG 0.2 mg/kg was injected intravenously. The anastomotic site was then observed by a scope inserted transanally. The following items were examined in the areas of the anastomotic site with the highest- and lowest-fluorescence intensity: maximum fluorescence (Fmax), time from ICG injection to Fmax (Tmax), time from start of dyeing to Fmax (ΔT), and the contrast pattern of the mucosa. RESULTS Anastomotic leakage (AL) occurred in nine cases. Tmax and ΔT values of the lowest-fluorescence area in the distal intestine showed significant differences in the cases with AL (P = 0.015 and P = 0.040, respectively). Regarding the contrast pattern of the mucosa of the lowest-fluorescence area in the proximal and distal intestine, the patients in whom the vessels were not depicted in the area had a significantly higher incidence of AL than those in whom vessels were depicted in the area (P = 0.031 and P = 0.030, respectively). Some of the areas in which vessels were not depicted by ICG fluorescence observation from the luminal side corresponded to the points of leakage. There were heterogeneous changes that might not be grasped by observation from the serosal side. CONCLUSION Transanal ICG fluorescence imaging can evaluate perfusion over the entire circumference of the anastomosis in detail and aid in assessing the risk of AL. Therefore, the examination of the detailed low-perfusion area enables us to take measures for AL and to search for safer operative managements.
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Affiliation(s)
- Hiroyuki Amagai
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8670, Japan.
| | - Hideaki Miyauchi
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8670, Japan
| | | | - Masaya Uesato
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8670, Japan
| | - Gaku Ohira
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8670, Japan
| | - Shunsuke Imanishi
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8670, Japan
| | - Tetsuro Maruyama
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8670, Japan
| | - Toru Tochigi
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8670, Japan
| | - Koichiro Okada
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8670, Japan
| | - Michihiro Maruyama
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8670, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8670, Japan
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Park SH, Park HM, Baek KR, Ahn HM, Lee IY, Son GM. Artificial intelligence based real-time microcirculation analysis system for laparoscopic colorectal surgery. World J Gastroenterol 2020; 26:6945-6962. [PMID: 33311942 PMCID: PMC7701947 DOI: 10.3748/wjg.v26.i44.6945] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colonic perfusion status can be assessed easily by indocyanine green (ICG) angiography to predict ischemia related anastomotic complications during laparoscopic colorectal surgery. Recently, various parameter-based perfusion analysis have been studied for quantitative evaluation, but the analysis results differ depending on the use of quantitative parameters due to differences in vascular anatomical structure. Therefore, it can help improve the accuracy and consistency by artificial intelligence (AI) based real-time analysis microperfusion (AIRAM).
AIM To evaluate the feasibility of AIRAM to predict the risk of anastomotic complication in the patient with laparoscopic colorectal cancer surgery.
METHODS The ICG curve was extracted from the region of interest (ROI) set in the ICG fluorescence video of the laparoscopic colorectal surgery. Pre-processing was performed to reduce AI performance degradation caused by external environment such as background, light source reflection, and camera shaking using MATLAB 2019 on an I7-8700k Intel central processing unit (CPU) PC. AI learning and evaluation were performed by dividing into a training patient group (n = 50) and a test patient group (n = 15). Training ICG curve data sets were classified and machine learned into 25 ICG curve patterns using a self-organizing map (SOM) network. The predictive reliability of anastomotic complications in a trained SOM network is verified using test set.
RESULTS AI-based risk and the conventional quantitative parameters including T1/2max, time ratio (TR), and rising slope (RS) were consistent when colonic perfusion was favorable as steep increasing ICG curve pattern. When the ICG graph pattern showed stepped rise, the accuracy of conventional quantitative parameters decreased, but the AI-based classification maintained accuracy consistently. The receiver operating characteristic curves for conventional parameters and AI-based classification were comparable for predicting the anastomotic complication risks. Statistical performance verifications were improved in the AI-based analysis. AI analysis was evaluated as the most accurate parameter to predict the risk of anastomotic complications. The F1 score of the AI-based method increased by 31% for T1/2max, 8% for TR, and 8% for RS. The processing time of AIRAM was measured as 48.03 s, which was suitable for real-time processing.
CONCLUSION In conclusion, AI-based real-time microcirculation analysis had more accurate and consistent performance than the conventional parameter-based method.
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Affiliation(s)
- Sang-Ho Park
- Department of Electronic Engineering, Pusan National University, Busan 46241, South Korea
| | - Hee-Min Park
- Department of Electronic Engineering, Pusan National University, Busan 46241, South Korea
| | - Kwang-Ryul Baek
- Department of Electronic Engineering, Pusan National University, Busan 46241, South Korea
| | - Hong-Min Ahn
- Department of Surgery, Pusan National University Yangsan Hospital, Gyeongsangnam-do 50612, South Korea
| | - In Young Lee
- Department of Medicine, Pusan National University, Gyeongsangnam-do 50612, South Korea
| | - Gyung Mo Son
- Department of Surgery, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si 50612, South Korea
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31
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Coakley KM, Davis BR, Kasten KR. Complicated Diverticular Disease. Clin Colon Rectal Surg 2020; 34:96-103. [PMID: 33642949 DOI: 10.1055/s-0040-1716701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The modern management of colonic diverticular disease involves grouping patients into uncomplicated or complicated diverticulitis, after which the correct treatment paradigm is instituted. Recent controversies suggest overlap in management strategies between these two groups. While most reports still support surgical intervention for the treatment of complicated diverticular disease, more data are forthcoming suggesting complicated diverticulitis does not merit surgical resection in all scenarios. Given the significant risk for complication in surgery for diverticulitis, careful attention should be paid to patient and procedure selection. Here, we define complicated diverticulitis, discuss options for surgical intervention, and explain strategies for avoiding operative pitfalls that result in early and late postoperative complications.
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Affiliation(s)
- Kathleen M Coakley
- Department of Surgery, Carolinas HealthCare System, Charlotte, North Carolina
| | - Bradley R Davis
- Department of Surgery, Carolinas HealthCare System, Charlotte, North Carolina
| | - Kevin R Kasten
- Department of Surgery, Carolinas HealthCare System, Charlotte, North Carolina
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32
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Truse R, Nolten I, Schulz J, Herminghaus A, Holtmanns T, Gördes L, Raupach A, Bauer I, Picker O, Vollmer C. Topical Melatonin Improves Gastric Microcirculatory Oxygenation During Hemorrhagic Shock in Dogs but Does Not Alter Barrier Integrity of Caco-2 Monolayers. Front Med (Lausanne) 2020; 7:510. [PMID: 32984383 PMCID: PMC7484810 DOI: 10.3389/fmed.2020.00510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/23/2020] [Indexed: 12/21/2022] Open
Abstract
Systemic administration of melatonin exerts tissue protective effects in the context of hemorrhagic shock. Intravenous application of melatonin prior to hemorrhage improves gastric microcirculatory perfusion and maintains intestinal barrier function in dogs. The aim of the present study was to analyze the effects of a topical mucosal melatonin application on gastric microcirculation during hemorrhagic shock in vivo and on mucosal barrier function in vitro. In a randomized cross-over study, six anesthetized female foxhounds received 3.3 mg melatonin or the vehicle as a bolus to the gastric and oral mucosa during physiological and hemorrhagic (-20% blood volume) conditions. Microcirculation was analyzed with reflectance spectrometry and laser doppler flowmetry. Systemic hemodynamic variables were measured with transpulmonary thermodilution. For analysis of intestinal mucosal barrier function in vitro Caco-2 monolayers were used. The transepithelial electrical resistance (TEER) and the passage of Lucifer Yellow (LY) from the apical to the basolateral compartment of Transwell chambers were measured. Potential barrier protective effects of melatonin against oxidative stress were investigated in the presence of the oxidant H2O2. During physiologic conditions topical application of melatonin had no effect on gastric and oral microcirculation in vivo. During hemorrhagic shock, gastric microcirculatory oxygenation (μHbO2) was decreased from 81 ± 8% to 50 ± 15%. Topical treatment with melatonin led to a significant increase in μHbO2 to 60 ± 13%. Topical melatonin treatment had no effect on gastric microcirculatory perfusion, oral microcirculation or systemic hemodynamics. Incubation of H2O2 stressed Caco-2 monolayers with melatonin did neither influence transepithelial electrical resistance nor LY translocation. Topical treatment of the gastric mucosa with melatonin attenuates the shock induced decrease in microcirculatory oxygenation. As no effects on local microcirculatory and systemic perfusion were recorded, the improved μHbO2 is most likely caused by a modulation of local oxygen consumption. In vitro melatonin treatment did not improve intestinal barrier integrity in the context of oxidative stress. These results extend the current knowledge on melatonin's protective effects during hemorrhage in vivo. Topical application of melatonin exerts differential effects on local microcirculation compared to systemic pretreatment and might be suitable as an adjunct for resuscitation of hemorrhagic shock.
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Affiliation(s)
- Richard Truse
- Department of Anesthesiology, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Inga Nolten
- Department of Anesthesiology, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Jan Schulz
- Department of Anesthesiology, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Anna Herminghaus
- Department of Anesthesiology, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Tobias Holtmanns
- Department of Anesthesiology, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Lukas Gördes
- Department of Anesthesiology, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Annika Raupach
- Department of Anesthesiology, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Inge Bauer
- Department of Anesthesiology, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Olaf Picker
- Department of Anesthesiology, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Christian Vollmer
- Department of Anesthesiology, Düsseldorf University Hospital, Düsseldorf, Germany
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33
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The Italian ColoRectal Anastomotic Leakage (iCral) study group. Risk factors for adverse events after elective colorectal surgery: beware of blood transfusions. Updates Surg 2020; 72:811-819. [PMID: 32399595 DOI: 10.1007/s13304-020-00753-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/20/2020] [Indexed: 01/19/2023]
Abstract
Purpose of the present study is to analyze risk factors for adverse events after elective colorectal resection. A wide range of adverse events after elective colorectal surgery was reported, anastomotic leakage (AL) and related morbidity and mortality being the most feared ones. Clear definition of risk factors is crucial to limit the related mortality. Prospective, 1-year multicenter enrollment of 1546 elective colorectal resections with anastomosis. Endpoints were anastomotic leakage (AL), overall morbidity, major morbidity and mortality rates (ClinicalTrials.gov; Identifier: NCT03560180). AL rate was 4.92%. Overall morbidity, major morbidity and mortality rates were 30.20%, 9.76% and 1.29%, respectively. Intra- and/or postoperative blood transfusion(s) was the only variable independently influencing all the endpoints: Odds ratios (OR) were 8.15 for AL, 19.33 for overall morbidity, 10.17 for major morbidity and 3.70 for mortality); overall morbidity rates were also independently influenced by American Society of Anesthesiologists class III vs I-II and extra- vs intra-corporeal anastomosis (OR 1.57 and 1.49, respectively); major morbidity rates were also independently influenced by female vs male gender and by the length of the procedure (OR 0.60 and 1.004, respectively); mortality rates were also independently influenced by increasing age (OR 1.16). This study clearly identifies intra- and/or postoperative blood transfusion(s) as an independent risk factor for all adverse events after elective colorectal surgery.
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34
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Mori M, Shuto K, Hirano A, Kosugi C, Narushima K, Hosokawa I, Fujino M, Yamazaki M, Shimizu H, Koda K. A Novel Parameter Identified Using Indocyanine Green Fluorescence Angiography may Contribute to Predicting Anastomotic Leakage in Gastric Cancer Surgery. World J Surg 2020; 44:2699-2708. [PMID: 32227275 DOI: 10.1007/s00268-020-05488-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anastomotic leak is one of the most serious postoperative complications, and intraoperative adequate perfusion plays a key role in preventing its development in gastric cancer surgery. This study aimed to investigate the relationships between anastomotic leak and the parameters defined by an assessment of intraoperative anastomotic perfusion using a near-infrared indocyanine green (ICG) fluorescence system and to evaluate the usefulness of this ICG fluorescence assessment in gastric cancer surgery. METHODS We retrospectively reviewed data of 100 patients who underwent gastric cancer surgery. In a visual assessment based on fluorescence intensity, we classified ICG fluorescence image patterns as homogeneous, heterogeneous, or faint. In a chronological assessment, the first or second time point of ICG fluorescence appearance on one or the other side of the anastomosis was defined as FT or ST, respectively. The time difference in ICG fluorescence appearance between FT and ST was defined as TD. The relationships between anastomotic leak and the evaluated clinical factors, including the parameters identified by the ICG fluorescence assessment, were evaluated using univariate or multivariate analysis. RESULTS Although no signs of leak were found by surgeons' subjective judgments, four patients developed postoperative anastomotic leak of Clavien-Dindo grade III or IV. Multivariate analysis revealed that TD was an independent predictor of anastomotic leak (odds ratio 35.361, 95% confidence interval 1.489-839.923, p = 0.027). CONCLUSIONS A novel parameter identified using near-infrared ICG fluorescence assessment may be useful to predict anastomotic leak in gastric cancer surgery. TRIAL REGISTRATION UMIN Clinical Trials Registry: #UMIN000030747 ( https://www.umin.ac.jp/ctr/index.htm ).
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Affiliation(s)
- Mikito Mori
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan.
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare Ichikawa Hospital, 6-1-14 Kounodai, Ichikawa, Chiba, 272-0827, Japan.
| | - Kiyohiko Shuto
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Atsushi Hirano
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare Ichikawa Hospital, 6-1-14 Kounodai, Ichikawa, Chiba, 272-0827, Japan
| | - Chihiro Kosugi
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Kazuo Narushima
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare Ichikawa Hospital, 6-1-14 Kounodai, Ichikawa, Chiba, 272-0827, Japan
| | - Isamu Hosokawa
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Masafumi Fujino
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Masato Yamazaki
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Hiroaki Shimizu
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Keiji Koda
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
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35
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Kojima S, Sakamoto T, Matsui Y, Nambu K, Masamune K. Clinical efficacy of bowel perfusion assessment during laparoscopic colorectal resection using laser speckle contrast imaging: A matched case-control study. Asian J Endosc Surg 2020; 13:329-335. [PMID: 31691522 DOI: 10.1111/ases.12759] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/04/2019] [Accepted: 09/12/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Disadvantages of bowel perfusion assessment with indocyanine green fluorescence angiography include the need for a fluorophore and the subjective nature of the assessment. This study was performed to evaluate the clinical efficacy of bowel perfusion assessment using laser speckle contrast imaging (LSCI) during laparoscopic colorectal surgery. METHODS The study population comprised the first 27 consecutive patients who underwent laparoscopic left-sided colorectal resection with intraoperative perfusion assessment using LSCI. The operative outcomes of these patients were compared with those of a matched group of patients without perfusion assessment. We analyzed the flux data expressed in laser speckle perfusion units. RESULTS After propensity score matching, we found no significant between-group differences in the patients' characteristics with the exception of the cancer stage. No patients undergoing LSCI perfusion assessment developed anastomotic leakage, but five (18.5%) patients in the control group did, at a significantly higher rate in male patients (P = .042). There were no significant differences in other operative outcomes. The laser speckle perfusion unit values after ligating marginal vessels were significantly lower than before ligation (P < .01). CONCLUSIONS With respect to anastomotic leakage, LSCI may improve patient outcomes after colorectal surgery. This technique appears to be a superior tool with the advantages of measurement repeatability and quantitativity and no need for a fluorophore.
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Affiliation(s)
- Shigehiro Kojima
- Department of Surgery, Sainokuni Higashiomiya Medical Center, Saitama, Japan.,Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Tokyo, Japan
| | - Tsuguo Sakamoto
- Department of Surgery, Sainokuni Higashiomiya Medical Center, Saitama, Japan
| | - Yutaka Matsui
- Faculty of Advanced Techno-Surgery, Institute of Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Kyojiro Nambu
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Tokyo, Japan
| | - Ken Masamune
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Tokyo, Japan
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36
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Moukarzel LA, Byrne ME, Leiva S, Wu M, Zhou QC, Iasonos A, Abu-Rustum NR, Sonoda Y, Gardner G, Leitao MM, Broach VA, Chi DS, Long Roche K, Zivanovic O. The impact of near-infrared angiography and proctoscopy after rectosigmoid resection and anastomosis performed during surgeries for gynecologic malignancies. Gynecol Oncol 2020; 158:397-401. [PMID: 32460995 DOI: 10.1016/j.ygyno.2020.05.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/13/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Reducing anastomotic leak rates after rectosigmoid resection and anastomosis is a priority in patients undergoing gynecologic oncology surgery. Therefore, we investigated the implications of performing near-infrared angiography (NIR) via proctoscopy to assess anastomotic perfusion at the time of rectosigmoid resection and anastomosis. METHODS We identified all patients who underwent rectosigmoid resection and anastomosis for a gynecologic malignancy between January 1, 2013 and December 31, 2018. NIR proctoscopy was assessed via the PINPOINT Endoscopic Imaging System (Stryker). RESULTS A total of 410 patients were identified, among whom NIR was utilized in 133 (32.4%). There were no statistically significant differences in age, race, BMI, type of malignancy, surgery, histology, FIGO stage, hypertension, diabetes, or preoperative chemotherapy between NIR and non-NIR groups. All cases of rectosigmoid resection underwent stapled anastomosis. The anastomotic leak rate was 2/133 (1.5%) in the NIR cohort compared with 13/277 (4.7%) in the non-NIR cohort (p = 0.16). Diverting ostomy was performed in 9/133 (6.8%) NIR and 53/277 (19.9%) non-NIR patients (p < 0.001). Postoperative abscesses occurred in 8/133 (6.0%) NIR and 44/277 (15.9%) non-NIR patients (p = 0.004). The NIR cohort had significantly fewer post-operative interventional procedures (12/133, 9.0% NIR vs. 55/277, 19.9% non-NIR, p = 0.006) and significantly fewer 30-day readmissions (14/133, 10.5% NIR vs. 61/277, 22% non-NIR, p = 0.004). CONCLUSIONS NIR proctoscopy is a safe tool for assessing anastomotic rectal perfusion after rectosigmoid resection and anastomosis, with a low anastomotic leak rate of 1.5%. Its potential usefulness should be evaluated in randomized trials in patients undergoing gynecologic cancer surgery.
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Affiliation(s)
- Lea A Moukarzel
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maureen E Byrne
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stephanie Leiva
- Department of Surgery, Hurley Medical Center, Flint, MI, USA
| | - Michelle Wu
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qin C Zhou
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Ginger Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Vance A Broach
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA.
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Adusumilli PS, Bikson M, Rizk NP, Rusch VW, Hristov B, Grosser R, Tan KS, Sarkaria IS, Huang J, Molena D, Jones DR, Bains MS. A prospective trial of intraoperative tissue oxygenation measurement and its association with anastomotic leak rate after Ivor Lewis esophagectomy. J Thorac Dis 2020; 12:1449-1459. [PMID: 32395282 PMCID: PMC7212129 DOI: 10.21037/jtd.2020.02.58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Anastomotic leak following Ivor Lewis esophagectomy is associated with increased morbidity/mortality and decreased survival. Tissue oxygenation at the anastomotic site may influence anastomotic leak. Methods for establishing tissue oxygenation at the anastomotic site are lacking. Methods Over a 2-year study period, 185 Ivor Lewis esophagectomies were performed. Study participants underwent measurement of gastric conduit tissue oxygenation at the planned anastomotic site using the wireless pulse oximetry device. Associations between anastomotic leaks or strictures and tissue oxygenation levels were analyzed using Wilcoxon rank sum test or Fisher’s exact test. Results Among study participants (n=114), median gastric conduit tissue oxygenation level was 92% (range, 62–100%). There were 8 (7.0%) anastomotic leaks and 3 (2.6%) strictures. Analysis of tissue oxygenation as a continuous variable showed no difference in median tissue oxygenation in patients with and without leaks (98% and 92%; P=0.2) and stricture formation (89% and 92%; P=0.6). Analysis of tissue oxygenation as a dichotomous variable found no difference in anastomotic leak rates [7.5% (n=93) in >80% vs. 0% (n=20) in ≤80%; P=0.3]. There were no significant differences in leak rates in concurrent study nonparticipants. Conclusions No significant association was observed between intraoperative tissue oxygenation at the anastomotic site and subsequent anastomotic leak or stricture formation among patients undergoing Ivor Lewis esophagectomy.
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Affiliation(s)
- Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | - Nabil P Rizk
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Boris Hristov
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rachel Grosser
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Inderpal S Sarkaria
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Manjit S Bains
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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38
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Soares AS, Chand M. Future Directions. Clin Colon Rectal Surg 2020; 33:180-186. [PMID: 32368200 PMCID: PMC7192688 DOI: 10.1055/s-0039-3402781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Transanal total mesorectal excision (taTME) is a novel technique that has evolved over the years to address the challenges of low rectal cancer surgery by applying the principles and benefits of laparoscopic surgery to more historic transanal techniques. It has been popularized through its use in rectal cancer, but the transanal approach is slowly being expanded to tackle different clinical scenarios including benign conditions such as inflammatory bowel disease and endometriosis. For all of these new indications, it is the desire to access and begin the dissection in native tissue beyond the pathology which makes this approach applicable to other diseases where anatomy can be challenging. Training pathways to safely introduce taTME in a standardized manner are being developed and implemented in a bid to ensure adequate training to all the surgeons using this technique and thus minimize complications and patient morbidity. The future directions of this promising technique include the use of image and optical technological enhancement to aid navigation, the use of pneumorectum stabilization, and perhaps the use of fluorescence as a safety improvement. Developments have come also from the field of robotics. After a demonstration of feasibility in cadaver models, a growing experience has been gathered in the robotic approach to taTME, covered in the last part of this chapter.
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Affiliation(s)
- António S. Soares
- Department of Surgery and Interventional Sciences, GENIE Centre, University College London, University College London Hospitals, NHS Trust, London, UK
| | - Manish Chand
- Department of Surgery and Interventional Sciences, GENIE Centre, University College London, University College London Hospitals, NHS Trust, London, UK
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39
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Tavy ALM, de Bruin AFJ, Smits AB, Boerma EC, Ince C, Noordzij PG, Boerma D, van Iterson M. Intestinal Mucosal and Serosal Microcirculation at the Planned Anastomosis during Abdominal Surgery. Eur Surg Res 2020; 60:248-256. [PMID: 31935725 DOI: 10.1159/000505325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/10/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Intestinal blood flow is often named as a key factor in the pathophysiology of anastomotic leakage. The distribution between mucosal and serosal microperfusion during surgery remains to be elucidated. OBJECTIVE The aim of this study was to assess if the mucosal microcirculation of the intestine is more vulnerable to a surgical hit than the serosal microcirculation during surgery. METHODS In an observational cohort study (n = 9 patients), the microcirculation of the bowel serosa and mucosa was visualized with incident dark-field imaging during surgery. At the planned anastomosis, the following microcirculatory parameters were determined: microvascular flow index (MFI), percentage of perfused vessels (PPV), perfused vessel density (PVD), and total vessel density (TVD). Data are presented as median (interquartile range [IQR]). RESULTS Perfusion parameters and vessel density were significantly higher for the mucosa than the serosal microcirculation at the planned site for anastomosis or stoma. Mucosal MFI was 3.00 (IQR 3.00-3.00) compared to a serosal MFI of 2.75 (IQR 2.21-2.94), p = 0.03. The PPV was 99% (IQR 98-100) versus 92% (IQR 66-94), p = 0.01. The TVD was 16.77 mm/mm2 (IQR 13.04-18.01) versus 10.42 mm/mm2 (IQR 9.36-11.81), p = 0.01, and the PVD was 15.44 mm/mm2 (IQR 13.04-17.78) versus 9.02 mm/mm2 (IQR 6.43-9.43), p = 0.01. CONCLUSIONS The mucosal microcirculation was preserved, while lower perfusion of the serosa was found at the planned anastomosis or stoma during surgery. Further research is needed to link our observations to the clinically relevant endpoint of anastomotic leakage.
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Affiliation(s)
- Arthur L M Tavy
- Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands,
| | - Anton F J de Bruin
- Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Anke B Smits
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - E Christiaan Boerma
- Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Can Ince
- Department of Intensive Care Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter G Noordzij
- Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Djamila Boerma
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Mat van Iterson
- Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
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Casey P, Chaudhury MP, Khan A, Amin J, Afzal A, Corallo C, Sebastian D, Atkinson M, Subar D. The impact of perioperative inotropes on the incidence of pancreatic leak following pancreaticoduodenectomy. Ann Hepatobiliary Pancreat Surg 2019; 23:392-396. [PMID: 31825007 PMCID: PMC6893053 DOI: 10.14701/ahbps.2019.23.4.392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 01/08/2023] Open
Abstract
Backgrounds/Aims Pancreatic leak and fistula formation following pancreatic resection is a dreaded complication associated with significant morbidity and mortality. The perioperative use of inotropes has been implicated in anastomotic dehiscence in other types of gastrointestinal surgery but their impact in pancreatic surgery remains unclear and a potentially modifiable risk factor for pancreatic leak. This study aims to assess the impact of perioperative inotrope infusion on the incidence of pancreatic leak following pancreaticoduodenectomy. Methods Retrospective data analysis of all patients undergoing pancreaticoduodenectomy at a tertiary HPB institute. Multivariate analysis and regression models assessed the impact of inotrope use against other known risk factors such as pancreatic duct size and gland texture. Pancreatic fistulae were graded as per ISGPF as Grade A (biochemical leak), Grade B and Grade C fistula. Results One-hundred and twenty-three (123) patients were included. A total of 52 patients (42%) developed a leak (29 grade A, 15 grade B, and 8 Grade C). In the fistula group, 28 patients (55%) received perioperative inotropes compared to 26 (35%) in the no fistula group. On univariate analysis, patients receiving inotropes (p=0.04) and patients with a soft pancreatic texture (p=0.003) had a statistically higher incidence of developing a pancreatic fistula of any grade. On multivariate analysis, only inotrope use was associated with an increased risk of developing a pancreatic fistula of any grade (OR 2.46, p=0.026), independent of pancreatic texture and pancreatic duct size. Conclusions Perioperative inotrope use is associated with an increase incidence of pancreatic leak following pancreaticoduodenectomy and should therefore be used judiciously.
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Affiliation(s)
- Patrick Casey
- Department of HPB Surgery, East Lancashire NHS Hospital Trust, Blackburn, UK
| | | | - Asaad Khan
- Department of HPB Surgery, East Lancashire NHS Hospital Trust, Blackburn, UK
| | - Jebran Amin
- Department of HPB Surgery, East Lancashire NHS Hospital Trust, Blackburn, UK
| | - Abdul Afzal
- Department of HPB Surgery, East Lancashire NHS Hospital Trust, Blackburn, UK
| | - Carmello Corallo
- Department of HPB Surgery, East Lancashire NHS Hospital Trust, Blackburn, UK
| | - Domnic Sebastian
- Department of Anaesthesia, East Lancashire NHS Hospital Trust, Blackburn, UK
| | - Matthew Atkinson
- Department of Anaesthesia, East Lancashire NHS Hospital Trust, Blackburn, UK
| | - Daren Subar
- Department of HPB Surgery, East Lancashire NHS Hospital Trust, Blackburn, UK
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Truse R, Smyk M, Schulz J, Herminghaus A, Weber APM, Mettler-Altmann T, Bauer I, Picker O, Vollmer C. Regional hypothermia improves gastric microcirculatory oxygenation during hemorrhage in dogs. PLoS One 2019; 14:e0226146. [PMID: 31821374 PMCID: PMC6903746 DOI: 10.1371/journal.pone.0226146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/20/2019] [Indexed: 01/03/2023] Open
Abstract
Mild systemic hypothermia increases gastric mucosal oxygenation (μHbO2) during hemorrhagic shock in dogs. In the context of critical blood loss hypothermia might be fatal due to adverse side effects. Selective regional hypothermia might overcome these limitations. The aim of our study was to analyze the effects of regional gastric and oral mucosal hypothermia on μHbO2 and perfusion (μflow). In a cross-over study six anesthetized dogs were subjected to local oral and gastric mucosal hypothermia (34°C), or maintenance of local normothermia during normovolemia and hemorrhage (-20% blood volume). Macro- and microcirculatory variables were recorded continuously. During normovolemia, local hypothermia increased gastric microcirculatory flow (μflow) without affecting oxygenation (μHbO2) or oral microcirculation. During mild hemorrhagic shock gastric μHbO2 decreased from 72±2% to 38±3% in the normothermic group. This was attenuated by local hypothermia, where μHbO2 was reduced from 74±3% to 52±4%. Local perfusion, oral microcirculation and macrocirculatory variables were not affected. Selective local hypothermia improves gastric μHbO2 during hemorrhagic shock without relevant side effects. In contrast to systemic hypothermia, regional mucosal hypothermia did not affect perfusion and oxygen supply during hemorrhage. Thus, the increased μHbO2 during local hypothermia rather indicates reduced mucosal oxygen demand.
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Affiliation(s)
- Richard Truse
- Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
- * E-mail:
| | - Michael Smyk
- Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Jan Schulz
- Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Anna Herminghaus
- Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Andreas P. M. Weber
- Institute of Plant Biochemistry, Cluster of Excellence on Plant Sciences (CEPLAS), Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Tabea Mettler-Altmann
- Institute of Plant Biochemistry, Cluster of Excellence on Plant Sciences (CEPLAS), Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Inge Bauer
- Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Olaf Picker
- Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Christian Vollmer
- Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
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Shen Z, An Y, Shi Y, Yin M, Xie Q, Gao Z, Jiang K, Wang S, Ye Y. The Aortic Calcification Index is a risk factor associated with anastomotic leakage after anterior resection of rectal cancer. Colorectal Dis 2019; 21:1397-1404. [PMID: 31361381 DOI: 10.1111/codi.14795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 05/14/2019] [Indexed: 12/17/2022]
Abstract
AIM Anastomotic leakage (AL) is one of the most feared postoperative complications after anterior resection (AR) of rectal cancer. An adequate blood supply at the anastomotic site is regarded as a prerequisite for healing. We hypothesize that the Aortic Calcification Index (ACI) might reflect the severity of atherosclerosis in patients, and thereby be a risk factor for AL. METHOD AL was investigated retrospectively according to the definition of the International Study Group of Rectal Cancer in 423 rectal cancer patients who underwent anterior rectal resection. The ACI was measured by preoperative abdominal CT scan. The cross-section of the aorta was evenly divided into 12 sectors, the number of calcified sectors was counted as the calcification score of each slice. Lasso logistic regression and multivariate regression analysis were used to identify risk factors for AL. RESULTS The percentage of AL after AR was 7.8% (33/423); the mortality of patients who sustained a leak was 3.0% (1/33). Patients with a high ACI had a significantly higher percentage of AL than patients with low ACI (11.2% vs 5.6%, P = 0.04). Among patients with AL, a higher ACI was associated with greater severity of AL (the ACI of patients with grade A leakage, grade B leakage and grade C leakage was 0.5% ± 0.2%, 11.5% ± 9.2% and 24.2% ± 21.7%, respectively; P = 0.008). After risk adjustment, multivariate regression analysis showed that a higher ACI was an independent risk factor for AL (OR 2.391, P = 0.04). CONCLUSION A high ACI might be an important prognostic factor for AL after AR for rectal cancer. Confirmatory studies are required.
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Affiliation(s)
- Z Shen
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, China
| | - Y An
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, China
| | - Y Shi
- Clinical Epidemiology and EBM Unit, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Beijing, China
| | - M Yin
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, China
| | - Q Xie
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, China
| | - Z Gao
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, China
| | - K Jiang
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, China
| | - S Wang
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, China
| | - Y Ye
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, China
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Chang YK, Foo CC, Yip J, Wei R, Ng KK, Lo O, Choi HK, Law WL. The impact of indocyanine-green fluorescence angiogram on colorectal resection. Surgeon 2019; 17:270-276. [DOI: 10.1016/j.surge.2018.08.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/08/2018] [Accepted: 08/16/2018] [Indexed: 02/07/2023]
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Gray ME, Marland JRK, Dunare C, Blair EO, Meehan J, Tsiamis A, Kunkler IH, Murray AF, Argyle D, Dyson A, Singer M, Potter MA. In vivo validation of a miniaturized electrochemical oxygen sensor for measuring intestinal oxygen tension. Am J Physiol Gastrointest Liver Physiol 2019; 317:G242-G252. [PMID: 31188641 PMCID: PMC6734375 DOI: 10.1152/ajpgi.00050.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Recent advances in the fields of electronics and microfabrication techniques have led to the development of implantable medical devices for use within the field of precision medicine. Monitoring visceral surface tissue O2 tension (PTo2) by means of an implantable sensor is potentially useful in many clinical situations, including the perioperative management of patients undergoing intestinal resection and anastomosis. This concept could provide a means by which treatment could be tailored to individual patients. This study describes the in vivo validation of a novel, miniaturized electrochemical O2 sensor to provide real-time data on intestinal PTo2. A single O2 sensor was placed onto the serosal surface of the small intestine of anesthetized rats that were exposed to ischemic (superior mesenteric artery occlusion) and hypoxemic (alterations in inspired fractional O2 concentrations) insults. Control experiments demonstrated that the sensors can function and remain stable in an in vivo environment. Intestinal PTo2 decreased following superior mesenteric artery occlusion and with reductions in inspired O2 concentrations. These results were reversible after reinstating blood flow or by increasing inspired O2 concentrations. We have successfully developed an anesthetized rat intestinal ischemic and hypoxic model for validation of a miniaturized O2 sensor to provide real-time measurement of intestinal PTo2. Our results support further validation of the sensors in physiological conditions using a large animal model to provide evidence of their use in clinical applications where monitoring visceral surface tissue O2 tension is important.NEW & NOTEWORTHY This is the first report of real-time continuous measurements of intestinal oxygen tension made using a microfabricated O2 sensor. Using a developed rodent model, we have validated this sensor's ability to accurately measure dynamic and reversible changes in intestinal oxygenation that occur through ischemic and hypoxemic insults. Continuous monitoring of local intestinal oxygenation could have value in the postoperative monitoring of patients having undergone intestinal surgery.
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Affiliation(s)
- Mark E. Gray
- 1The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom,2Cancer Research United Kingdom Edinburgh Centre and Division of Pathology Laboratories, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Jamie R. K. Marland
- 3School of Engineering, Institute for Integrated Micro and Nano Systems, Edinburgh, United Kingdom
| | - Camelia Dunare
- 3School of Engineering, Institute for Integrated Micro and Nano Systems, Edinburgh, United Kingdom
| | - Ewen O. Blair
- 3School of Engineering, Institute for Integrated Micro and Nano Systems, Edinburgh, United Kingdom
| | - James Meehan
- 2Cancer Research United Kingdom Edinburgh Centre and Division of Pathology Laboratories, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Andreas Tsiamis
- 3School of Engineering, Institute for Integrated Micro and Nano Systems, Edinburgh, United Kingdom
| | - Ian H. Kunkler
- 3School of Engineering, Institute for Integrated Micro and Nano Systems, Edinburgh, United Kingdom
| | - Alan F. Murray
- 3School of Engineering, Institute for Integrated Micro and Nano Systems, Edinburgh, United Kingdom
| | - David Argyle
- 1The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Alex Dyson
- 4Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
| | - Mervyn Singer
- 4Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
| | - Mark A. Potter
- 5Department of Surgery, Western General Hospital, Edinburgh, United Kingdom
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Strowitzki MJ, Ritter AS, Kimmer G, Schneider M. Hypoxia-adaptive pathways: A pharmacological target in fibrotic disease? Pharmacol Res 2019; 147:104364. [PMID: 31376431 DOI: 10.1016/j.phrs.2019.104364] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/19/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023]
Abstract
Wound healing responses are physiological reactions to injuries and share common characteristics and phases independently of the injured organ or tissue. A major hallmark of wound healing responses is the formation of extra-cellular matrix (ECM), mainly consisting of collagen fibers, to restore the initial organ architecture and function. Overshooting wound healing responses result in unphysiological accumulation of ECM and collagen deposition, a process called fibrosis. Importantly, hypoxia (oxygen demand exceeds supply) plays a significant role during wound healing responses and fibrotic diseases. Under hypoxic conditions, cells activate a gene program, including the stabilization of hypoxia-inducible factors (HIFs), which induces the expression of HIF target genes counteracting hypoxia. In contrast, in normoxia, so-called HIF-prolyl hydroxylases (PHDs) oxygen-dependently hydroxylate HIF-α, which marks it for proteasomal degradation. Importantly, PHDs can be pharmacologically inhibited (PHI) by so-called PHD inhibitors. There is mounting evidence that the HIF-pathway is continuously up-regulated during the development of tissue fibrosis, and that pharmacological (HIFI) or genetic inhibition of HIF can prevent organ fibrosis. By contrast, initial (short-term) activation of the HIF pathway via PHI during wound healing seems to be beneficial in several models of inflammation or acute organ injury. Thus, timing and duration of PHI and HIFI treatment seem to be crucial. In this review, we will highlight the role of hypoxia-adaptive pathways during wound healing responses and development of fibrotic disease. Moreover, we will discuss whether PHI and HIFI might be a promising treatment option in fibrotic disease, and consider putative pitfalls that might result from this approach.
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Affiliation(s)
- Moritz J Strowitzki
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Alina S Ritter
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Gwendolyn Kimmer
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
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Ogino T, Hata T, Kawada J, Okano M, Kim Y, Okuyama M, Tsujinaka T. The Risk Factor of Anastomotic Hypoperfusion in Colorectal Surgery. J Surg Res 2019; 244:265-271. [PMID: 31302324 DOI: 10.1016/j.jss.2019.06.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/04/2019] [Accepted: 06/14/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Inadequate blood flow is an important risk factor for anastomotic leakage. Indocyanine green (ICG) fluorescence imaging allows intraoperative assessment of intestinal blood flow. This study determined the risk factor of anastomotic hypoperfusion in colorectal surgery using ICG fluorescence imaging. METHODS This study included 74 consecutive patients who underwent colorectal surgery between April 2017 and March 2018. ICG was injected intravenously after dividing the mesentery and central vessels along the planned transection line, but before completing the anastomosis. Intraoperative blood flow was evaluated using ICG fluorescence imaging. With regard to the patient-, tumor-, and surgery-related factors, anastomotic perfusion was evaluated based on the changed transection line and prolonged (more than 60 s) perfusion time. RESULTS Intraoperative ICG fluorescence imaging was performed in all patients, and no adverse events were associated with ICG injection. Based on the perfusion assessment, we changed the transection line in six patients (8.1%). The prolonged perfusion time was observed in nine patients (12.2%). The postoperative course was uneventful in 63 (85.1%) patients, but one patient (1.4%) had postoperative anastomotic leakage. The changed transection line was significantly associated with anticoagulation therapy (P = 0.029). Well-known risk factors, including surgical site, sex, smoking, blood loss, operative time, and preoperative chemoradiotherapy, were not related to the changed transection line. Prolonged ICG perfusion time was not associated with any patient-, tumor-, or surgery-related factors. CONCLUSIONS The evaluation of intraoperative blood flow using ICG fluorescence imaging may be able to detect anastomotic hypoperfusion, and anticoagulation therapy is a risk factor of anastomotic hypoperfusion in colorectal surgery.
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Affiliation(s)
- Takayuki Ogino
- Department of Surgery, Kaizuka City Hospital, Osaka, Japan; Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
| | - Tomoki Hata
- Department of Surgery, Kaizuka City Hospital, Osaka, Japan
| | - Junji Kawada
- Department of Surgery, Kaizuka City Hospital, Osaka, Japan
| | - Miho Okano
- Department of Surgery, Kaizuka City Hospital, Osaka, Japan
| | - Yongkook Kim
- Department of Surgery, Kaizuka City Hospital, Osaka, Japan
| | - Masaki Okuyama
- Department of Surgery, Kaizuka City Hospital, Osaka, Japan
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Keeley TP, Mann GE. Defining Physiological Normoxia for Improved Translation of Cell Physiology to Animal Models and Humans. Physiol Rev 2019; 99:161-234. [PMID: 30354965 DOI: 10.1152/physrev.00041.2017] [Citation(s) in RCA: 216] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The extensive oxygen gradient between the air we breathe (Po2 ~21 kPa) and its ultimate distribution within mitochondria (as low as ~0.5-1 kPa) is testament to the efforts expended in limiting its inherent toxicity. It has long been recognized that cell culture undertaken under room air conditions falls short of replicating this protection in vitro. Despite this, difficulty in accurately determining the appropriate O2 levels in which to culture cells, coupled with a lack of the technology to replicate and maintain a physiological O2 environment in vitro, has hindered addressing this issue thus far. In this review, we aim to address the current understanding of tissue Po2 distribution in vivo and summarize the attempts made to replicate these conditions in vitro. The state-of-the-art techniques employed to accurately determine O2 levels, as well as the issues associated with reproducing physiological O2 levels in vitro, are also critically reviewed. We aim to provide the framework for researchers to undertake cell culture under O2 levels relevant to specific tissues and organs. We envisage that this review will facilitate a paradigm shift, enabling translation of findings under physiological conditions in vitro to disease pathology and the design of novel therapeutics.
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Affiliation(s)
- Thomas P Keeley
- King's British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London , London , United Kingdom
| | - Giovanni E Mann
- King's British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London , London , United Kingdom
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Kojima S, Sakamoto T, Nagai Y, Matsui Y, Nambu K, Masamune K. Laser Speckle Contrast Imaging for Intraoperative Quantitative Assessment of Intestinal Blood Perfusion During Colorectal Surgery: A Prospective Pilot Study. Surg Innov 2019; 26:293-301. [PMID: 30638132 DOI: 10.1177/1553350618823426] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The main limitation of perfusion assessment with indocyanine green fluorescence angiography during colorectal surgery is that the surgeon assesses the quality of perfusion subjectively. The ideal intestinal viability test must be minimally invasive, objective, and reproducible. We evaluated the quantitativity and reproducibility of laser speckle contrast imaging for perfusion assessment during colorectal surgery. METHODS This was a prospective, nonrandomized, pilot study of 8 consecutive patients who underwent elective left-sided colorectal resection. Laser speckle perfusion images at the site of proximal transection of the bowel were obtained intraoperatively. We tested the hypothesis that laser speckle contrast imaging was able to quantitatively identify areas of diminished intestinal perfusion after devascularization and assessed the reproducibility of this method. RESULTS All surgical procedures were uneventful and blood flow measurements were successfully made in all patients. None of the patients developed postoperative complications related to the anastomosis and stoma. Data analyses were successfully optimized to perform quantitative regional perfusion assessments in all cases. The bowel tissue blood flows of the anal side region adjacent to the transection line were significantly lower than those of the oral side region adjacent to the transection line after ligation of marginal vessels ( P = .012). Interrater reliability was high (intraclass correlation coefficients = 0.989), and a Bland-Altman plot showed few differences of mean flux data between 2 investigators. CONCLUSION Laser speckle contrast imaging is feasible for real-time assessment of bowel perfusion with quantitativity and excellent reproducibility during colorectal surgery without administration of any contrast agents.
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Affiliation(s)
- Shigehiro Kojima
- 1 Sainokuni Higashiomiya Medical Center, Saitama, Japan.,2 Joint Graduate School of Tokyo Women's Medical University and Waseda University, Tokyo, Japan
| | | | - Yuko Nagai
- 1 Sainokuni Higashiomiya Medical Center, Saitama, Japan
| | - Yutaka Matsui
- 3 Tokyo Women's Medical University, Tokyo, Japan.,4 Pioneer Corporation, Tokyo, Japan
| | - Kyojiro Nambu
- 2 Joint Graduate School of Tokyo Women's Medical University and Waseda University, Tokyo, Japan
| | - Ken Masamune
- 2 Joint Graduate School of Tokyo Women's Medical University and Waseda University, Tokyo, Japan
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Tavy ALM, de Bruin AFJ, van der Sloot K, Boerma EC, Ince C, Noordzij PG, Boerma D, van Iterson M. Effects of Thoracic Epidural Anaesthesia on the Serosal Microcirculation of the Human Small Intestine. World J Surg 2019; 42:3911-3917. [PMID: 30097706 DOI: 10.1007/s00268-018-4746-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The effect of thoracic epidural analgesia (TEA) on splanchnic blood flow during abdominal surgery remains unclear. The purpose of this study was to examine whether the hemodynamic effects of TEA resulted in microcirculatory alterations to the intestinal serosa, which was visualized using incident dark-field (IDF) videomicroscopy. METHODS An observational cohort study was performed. In 18 patients, the microcirculation of the intestinal serosa was visualized with IDF. Microcirculatory and hemodynamic measurements were performed prior to (T1) and after administering a bolus of levobupivacaine (T2). If correction of blood pressure was indicated, a third measurement was performed (T3). The following microcirculatory parameters were calculated: microvascular flow index, proportion of perfused vessels, perfused vessel density and total vessel density. Data are presented as median [IQR]. RESULTS Mean arterial pressure decreased from 73 mmHg (68-83) at T1 to 63 mmHg (±11) at T2 (p = 0.001) with a systolic blood pressure of 114 mmHg (98-128) and 87 (81-97), respectively (p = 0.001). The microcirculatory parameters of the bowel serosa, however, were unaltered. In seven patients, blood pressure was corrected to baseline values from a MAP of 56 mmHg (55-57), while microcirculatory parameters remained constant. CONCLUSION We examined the effects of TEA on the intestinal serosal microcirculation during abdominal surgery using IDF imaging for the first time in patients. Regardless of a marked decrease in hemodynamics, microcirculatory parameters of the bowel serosa were not significantly affected. TRIAL REGISTRY NUMBER ClinicalTrials.gov identifier NCT02688946.
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Affiliation(s)
- A L M Tavy
- Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Postbus 2500, 3430 EM, Nieuwegein, The Netherlands.
| | - A F J de Bruin
- Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Postbus 2500, 3430 EM, Nieuwegein, The Netherlands
| | - K van der Sloot
- Department of Anesthesiology and Pain Medicine, The Hague Medical Center, The Hague, The Netherlands
| | - E C Boerma
- Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - C Ince
- Department of Translational Physiology, Academic Medical Center, Amsterdam, The Netherlands
| | - P G Noordzij
- Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Postbus 2500, 3430 EM, Nieuwegein, The Netherlands
| | - D Boerma
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M van Iterson
- Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Postbus 2500, 3430 EM, Nieuwegein, The Netherlands
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The effects of intraoperative ICG fluorescence angiography in laparoscopic low anterior resection: a propensity score-matched study. Int J Clin Oncol 2018; 24:394-402. [DOI: 10.1007/s10147-018-1365-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/31/2018] [Indexed: 12/22/2022]
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