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Purpose <p>This study investigated the patient factors leading to ICG fluorescence angiography (ICG–FI)–guided surgical plan changes during rectal cancer surgery and evaluated the impact of these changes on anastomotic height and postoperative bowel function.</p> Methods <p>In a retrospective analysis of 302 patients undergoing laparoscopic low anterior resection, we compared 28 patients requiring perfusion-based plan changes (Change group) to 274 without changes (No-Change group). We analyzed demographics, anastomotic height, and 6-month LARS scores.</p> Results <p>The Change group had significantly older age, higher BMI, more neoadjuvant therapy, and lower tumor height. Their final anastomoses were higher (8.0 vs. 6.0&#xa0;cm, <i>p</i> &lt; 0.001). This group also had better bowel function, with lower LARS scores (18 vs. 25, <i>p</i> = 0.007) and fewer major LARS cases (14.3% vs. 32.1%, <i>p</i> = 0.041). Anastomotic leakage rates were similar.</p> Conclusions <p>ICG–FI identifies patients with perfusion risk factors (age, obesity, neoadjuvant therapy, low tumors) who benefit from surgical plan modification. Guiding the proximal resection margin based on ICG assessment to create a higher, well-perfused anastomosis significantly improves functional outcomes, underscoring its role in personalized surgery.</p> Trial registration <p>The study was registered in the clinical trials registry with registration number NCT06270745.</p>

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Deep impact analysis of surgical strategy changes guided by indocyanine green fluorescence angiography in laparoscopic low anterior resection for rectal cancer

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月3日

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  • Xuan Qiu,
  • Victor A. Kashchenko,
  • Anatoly A. Zavrazhnov,
  • Timur S. Lankov,
  • Litian Ye,
  • Valery V. Strizheletsky,
  • Georgy A. Smirnov

摘要

Purpose

This study investigated the patient factors leading to ICG fluorescence angiography (ICG–FI)–guided surgical plan changes during rectal cancer surgery and evaluated the impact of these changes on anastomotic height and postoperative bowel function.

Methods

In a retrospective analysis of 302 patients undergoing laparoscopic low anterior resection, we compared 28 patients requiring perfusion-based plan changes (Change group) to 274 without changes (No-Change group). We analyzed demographics, anastomotic height, and 6-month LARS scores.

Results

The Change group had significantly older age, higher BMI, more neoadjuvant therapy, and lower tumor height. Their final anastomoses were higher (8.0 vs. 6.0 cm, p < 0.001). This group also had better bowel function, with lower LARS scores (18 vs. 25, p = 0.007) and fewer major LARS cases (14.3% vs. 32.1%, p = 0.041). Anastomotic leakage rates were similar.

Conclusions

ICG–FI identifies patients with perfusion risk factors (age, obesity, neoadjuvant therapy, low tumors) who benefit from surgical plan modification. Guiding the proximal resection margin based on ICG assessment to create a higher, well-perfused anastomosis significantly improves functional outcomes, underscoring its role in personalized surgery.

Trial registration

The study was registered in the clinical trials registry with registration number NCT06270745.