Mesenteric Vascular Evaluation with Pre-operative Multidetector Computed Tomographic Angiography and Intraoperative Indocyanine Green Angiography to Reduce Anastomotic Leaks after Minimally Invasive Surgery for Colorectal Cancer br

Background: The aim of this prospective study was to determine the effect of mesenteric vascular evaluation using pre-operative multidetector computed tomography angiography (MDCTA) and intraoperative indocyanine green (ICG) angiography on reducing the anastomotic leak rate of colorectal cancer patients undergoing mini-mally invasive resection.Methods: Twenty-seven consecutive patients with colo-rectal cancer were studied, 18 males and 9 females, aver-age age 69.1 6 3.9 years. All patients underwent pre-operative mesenteric vascular evaluation using MDCTA with three-dimensional (3D) reconstruction and intrao-perative evaluation of perfusion using ICG angiography.Twelve patients underwent laparoscopic resection (Olympus Visera Elite II OTV-S200) and 15 patients underwent robotic resection (DaVinci Si). Colorectal resection lines and anastomoses were guided by intrao-perative ICG perfusion. Postoperative anastomotic leaks were assessed.Results: Pre-operative MDCTA 3D reconstructions defined the left colic and sigmoid artery anatomy and guided operative planning. The intraoperative ICG angi-ography resulted in a change of the planned lines of resection in seven patients (26%). The rate of postopera-tive anastomotic leaks in this study was 0% (0/27), com-pared to a leak rate of 6.8% at our institution in the preceding two years.Conclusion: Pre-operative evaluation of mesenteric vas-cular anatomy using MDCTA with 3D reconstruction and intraoperative evaluation of perfusion using ICG angiog-raphy were found to be technically feasible and safe. An appropriately designed study should be undertaken to prove whether it was truly effective at reducing the post-operative anastomotic leak rate in colorectal cancer patients undergoing minimally invasive resection at our institution.