FTP2.10 Use of ICG in Assessing Anastomotic Perfusion – The First 100 Cases in a Tertiary Colorectal Cancer Unit

Abstract Aims This project aimed to investigate if using intra-operative indocyanine green (ICG) fluorescence imaging to assess anastomotic perfusion in colorectal surgery affected the rate of anastomotic leak. Methods Data was prospectively collected for the first 100 patients who underwent colorectal surgery with ICG used to assess the perfusion of the anastomotic ends. The rate of anastomotic leak was calculated. Results ICG was used in 100 patients undergoing colorectal procedures with anastomosis, from June 2016 to May 2022. 98 were elective cases, 53 patients were male with a median age of 65 years. After infusion of ICG and assessment of perfusion, the resection margin was changed in 13 procedures (13%). In cases where the resection margin was changed, there was 2 anastomotic leaks (leak rate 15%). In cases where the resection margin was unchanged, there was 3 anastomotic leaks (leak rate 3%). There was not a significant difference in the leak rate when a change in resection margin was made based on the use of ICG (p=0.065). Conclusions The results demonstrate that the use of ICG did not significantly change the rate of anastomotic leaks in patients undergoing bowel surgery with anastomoses. However, this information indicates that poor perfusion at ICG fluoroscopy can help identify those patients at risk of leak, which can be used in post-operative monitoring of patients with cancer undergoing major colorectal surgery. It also raises the question of whether we should be changing the resection line by even more when ICG indicates poor perfusion at the resected end.