The effect of intracorporeal versus extracorporeal anastomosis in robotic right colectomy on perianastomotic perfusion: a substudy to a multicenter RCT

Niclas Dohrn*, Carolin Oppermann, Helin Yikilmaz, Magnus Laursen, Faisal Khesrawi, Frederik Bjerg Clausen, Henrik Loft Jakobsen, Steffen Brisling, Jakob Lykke, Jens Ravn Eriksen, Mads Falk Klein, Ismail Gögenur

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftArtikelForskningpeer review

Abstract

PURPOSE: Previous studies have shown that intracorporeal anastomosis (ICA) in minimally invasive right colectomy may improve postoperative recovery compared with extracorporeal anastomosis (ECA). It has been hypothesized that creating the anastomosis extracorporeally may cause mesenteric traction and compromised intestinal perfusion. The purpose of this study was to investigate the effect of either ICA or ECA on intestinal perfusion.

METHOD: This was a substudy to a multicenter, triple-blind randomized clinical trial comparing ICA with ECA in patients undergoing robotic right colectomy for colonic cancer. Videos from intraoperative Indocyanine Green (ICG) fluorescence imaging were analyzed with quantitative ICG perfusion assessment (q-ICG). q-ICG was performed by extracting perfusion metrics from a time-intensity curve generated from an image analysis software: F MAX: maximal fluorescence intensity, T MAX: time until maximal fluorescent signal, T 1/2MAX: time until half-maximal fluorescent signal, time ratio (T 1/2MAX/T MAX) and slope.

RESULTS: A total of 68 patients (33 ICA and 35 ECA) were available for analysis. Demographics were similar between the groups, except for mean arterial blood pressure at the time of ICG infusion, which was significantly lower in the ICA group. We found a significantly steeper slope in the ICA group compared to the ECA group (6.3 vs. 4.7 AU/sec, P = .048). There were no significant differences in F MAX, T MAX, T 1/2MAX, and time ratio.

CONCLUSION: We found evidence of an improved intestinal perfusion following ICA compared with ECA. This finding may be related to patient outcomes and should be explored further in the future.

CLINICALTRIALS: gov NCT03130166.

OriginalsprogEngelsk
Sider (fra-til)3577-3586
Antal sider10
TidsskriftLangenbeck's Archives of Surgery
Vol/bind407
Udgave nummer8
Tidlig onlinedato28 sep. 2022
DOI
StatusUdgivet - dec. 2022

Bibliografisk note

© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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