Application research of sidestream dark field imaging technology in laparoscopic anterior resection of rectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Shuang ¹ , JIA Guiqing ² , YUAN Hao ² , YANG Fuxun ³ ,  ZHAO Gaoping ^1,2

1. Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
2. Department of Gastrointestinal Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu 610072, P. R. China;
3. Department of Intensive Care Unit, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu 610072, P. R. China;

Corresponding author：

ZHAO Gaoping, Email: gzhao@uestc.edu.cn

Keywords：

sidestream dark field imaging technology; laparoscope; anterior resection of rectal cancer; anastomotic leakage; microcirculation

DOI：

10.7507/1007-9424.202111067

Video：

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Objective To evaluate the influence of sidestream dark field (SDF) imaging technology in laparoscopic anterior resection (LAR) of rectal cancer on postoperative anastomotic leakage. Methods According to the inclusion and exclusion criteria, the patients diagnosed with rectal cancer and underwent LAR of rectal cancer in the Sichuan Provincial People’s Hospital from October 2017 to October 2021 were retrospectively analyzed and then were divided into the study group and the control group according to whether SDF imaging technology was used during the operation. The intraoperative and postoperative data, especially the postoperative anastomotic leakage, were analyzed. Results A total of 90 patients were involved in this study, including 40 patients in the study group and 50 patients in the control group. There were no statistical differences in the baseline data such as gender, age, boby mass index and so on between the two groups (P>0.05). Except that the incidence of anastomotic leakage in the study group was lower than that in the control group (P<0.05), there were no statistical differences in other indexes during and after operation between the two groups (P>0.05). The operation plans were changed in 8 patients of the study group. Except for the total vessel density (P=0.962), the microvascular flow index, perfusion vessel proportion, and perfusion vessel density in the last measurement of these 8 patients were higher than those in the first measurement (P<0.05). Conclusion From preliminary results of this study, real-time evaluation of intestinal microcirculation by SDF imaging technology can help surgeons evaluate microcirculation perfusion at the intestinal anastomosis and provide an important reference for surgical decision-making.

Citation： LI Shuang, JIA Guiqing, YUAN Hao, YANG Fuxun, ZHAO Gaoping. Application research of sidestream dark field imaging technology in laparoscopic anterior resection of rectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(8): 1029-1033. doi: 10.7507/1007-9424.202111067 Copy

1.	Jafari MD, Wexner SD, Martz JE, et al. Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR Ⅱ): a multi-institutional study. J Am Coll Surg, 2015, 220(1): 82-92.
2.	徐通海, 贾贵清, 杨福勋, 等. 侧流暗视野成像技术在直肠吻合口微循环中的应用评价. 四川医学, 2021, 42(3): 217-221.
3.	Shandall A, Lowndes R, Young HL. Colonic anastomotic healing and oxygen tension. Br J Surg, 1985, 72(8): 606-609.
4.	Amin MB, Edge S, Greene FL, et al. AJCC cancer staging manual (8th Ed.). New York: Springer, 2017: 252-254.
5.	吴清, 陈海军, 周进. 直肠癌全系膜切除术后吻合口漏形成的危险因素分析. 中华普外科手术学杂志(电子版), 2021, 15(1): 43-45.
6.	Lin JK, Yueh TC, Chang SC, et al. The influence of fecal diversion and anastomotic leakage on survival after resection of rectal cancer. J Gastrointest Surg, 2011, 15(12): 2251-2261.
7.	Mirnezami A, Mirnezami R, Chandrakumaran K, et al. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg, 2011, 253(5): 890-899.
8.	Karliczek A, Harlaar NJ, Zeebregts CJ, et al. Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery. Int J Colorectal Dis, 2009, 24(5): 569-576.
9.	Foo CC, Ng KK, Tsang J, et al. Colonic perfusion assessment with indocyanine-green fluorescence imaging in anterior resections: a propensity score-matched analysis. Tech Coloproctol, 2020, 24(9): 935-942.
10.	Du CZ, Fan ZH, Yang YF, et al. Value of intra-operative Doppler sonographic measurements in predicting post-operative anastomotic leakage in rectal cancer: a prospective pilot study. Chin Med J (Engl), 2019, 132(18): 2168-2176.
11.	Kojima S, Sakamoto T, Matsui Y, et al. 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(3): 329-335.
12.	Watanabe J, Ishibe A, Suwa Y, et al. Indocyanine green fluorescence imaging to reduce the risk of anastomotic leakage in laparoscopic low anterior resection for rectal cancer: a propensity score-matched cohort study. Surg Endosc, 2020, 34(1): 202-208.
13.	Kojima S, Sakamoto T, Nagai Y, et al. Laser speckle contrast imaging for intraoperative quantitative assessment of intestinal blood perfusion during colorectal surgery: a prospective pilot study. Surg Innov, 2019, 26(3): 293-301.
14.	Urbanavičius L, Pattyn P, de Putte DV, et al. How to assess intestinal viability during surgery: a review of techniques. World J Gastrointest Surg, 2011, 3(5): 59-69.
15.	Trzeciak S, McCoy JV, Phillip Dellinger R, et al. Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis. Intensive Care Med, 2008, 34(12): 2210-2217.
16.	Schouten SB, De Bruin AF, Gosselink MP, et al. Is microvessel density correlated with anastomotic leakage after low anterior resection? Hepatogastroenterology, 2014, 61(129): 90-93.
17.	Diller R, Stratmann U, Helmschmied T, et al. Microcirculatory dysfunction in endotoxemic bowel anastomosis: the pathogenetic contribution of microcirculatory dysfunction to endotoxemia-induced healing impairment. J Surg Res, 2008, 150(1): 3-10.
18.	Jannasch O, Klinge T, Otto R, et al. Risk factors, short and long term outcome of anastomotic leaks in rectal cancer. Oncotarget, 2015, 6(34): 36884-36893.
19.	Hinoi T, Okajima M, Shimomura M, et al. Effect of left colonic artery preservation on anastomotic leakage in laparoscopic anterior resection for middle and low rectal cancer. World J Surg, 2013, 37(12): 2935-2943.
20.	常文举, 任黎, 许剑民. 2019年结直肠癌肝转移诊疗指南最新解读. 中国普外基础与临床杂志, 2019, 26(8): 907-911.
21.	Deng Y, Chi P, Lan P, et al. Modified FOLFOX6 with or without radiation versus fluorouracil and leucovorin with radiation in neoadjuvant treatment of locally advanced rectal cancer: initial results of the Chinese FOWARC multicenter, open-label, randomized three-arm phase Ⅲ trial. J Clin Oncol, 2016, 34(27): 3300-3307.
22.	Katayama H, Kurokawa Y, Nakamura K, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today, 2016, 46(6): 668-685.
23.	李子禹, 吴舟桥, 季加孚. 中国胃肠肿瘤外科术后并发症诊断登记规范专家共识(2018版). 中国实用外科杂志, 2018, 38(6): 589-595.

1. Jafari MD, Wexner SD, Martz JE, et al. Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR Ⅱ): a multi-institutional study. J Am Coll Surg, 2015, 220(1): 82-92.
2. 徐通海, 贾贵清, 杨福勋, 等. 侧流暗视野成像技术在直肠吻合口微循环中的应用评价. 四川医学, 2021, 42(3): 217-221.
3. Shandall A, Lowndes R, Young HL. Colonic anastomotic healing and oxygen tension. Br J Surg, 1985, 72(8): 606-609.
4. Amin MB, Edge S, Greene FL, et al. AJCC cancer staging manual (8th Ed.). New York: Springer, 2017: 252-254.
5. 吴清, 陈海军, 周进. 直肠癌全系膜切除术后吻合口漏形成的危险因素分析. 中华普外科手术学杂志(电子版), 2021, 15(1): 43-45.
6. Lin JK, Yueh TC, Chang SC, et al. The influence of fecal diversion and anastomotic leakage on survival after resection of rectal cancer. J Gastrointest Surg, 2011, 15(12): 2251-2261.
7. Mirnezami A, Mirnezami R, Chandrakumaran K, et al. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg, 2011, 253(5): 890-899.
8. Karliczek A, Harlaar NJ, Zeebregts CJ, et al. Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery. Int J Colorectal Dis, 2009, 24(5): 569-576.
9. Foo CC, Ng KK, Tsang J, et al. Colonic perfusion assessment with indocyanine-green fluorescence imaging in anterior resections: a propensity score-matched analysis. Tech Coloproctol, 2020, 24(9): 935-942.
10. Du CZ, Fan ZH, Yang YF, et al. Value of intra-operative Doppler sonographic measurements in predicting post-operative anastomotic leakage in rectal cancer: a prospective pilot study. Chin Med J (Engl), 2019, 132(18): 2168-2176.
11. Kojima S, Sakamoto T, Matsui Y, et al. 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(3): 329-335.
12. Watanabe J, Ishibe A, Suwa Y, et al. Indocyanine green fluorescence imaging to reduce the risk of anastomotic leakage in laparoscopic low anterior resection for rectal cancer: a propensity score-matched cohort study. Surg Endosc, 2020, 34(1): 202-208.
13. Kojima S, Sakamoto T, Nagai Y, et al. Laser speckle contrast imaging for intraoperative quantitative assessment of intestinal blood perfusion during colorectal surgery: a prospective pilot study. Surg Innov, 2019, 26(3): 293-301.
14. Urbanavičius L, Pattyn P, de Putte DV, et al. How to assess intestinal viability during surgery: a review of techniques. World J Gastrointest Surg, 2011, 3(5): 59-69.
15. Trzeciak S, McCoy JV, Phillip Dellinger R, et al. Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis. Intensive Care Med, 2008, 34(12): 2210-2217.
16. Schouten SB, De Bruin AF, Gosselink MP, et al. Is microvessel density correlated with anastomotic leakage after low anterior resection? Hepatogastroenterology, 2014, 61(129): 90-93.
17. Diller R, Stratmann U, Helmschmied T, et al. Microcirculatory dysfunction in endotoxemic bowel anastomosis: the pathogenetic contribution of microcirculatory dysfunction to endotoxemia-induced healing impairment. J Surg Res, 2008, 150(1): 3-10.
18. Jannasch O, Klinge T, Otto R, et al. Risk factors, short and long term outcome of anastomotic leaks in rectal cancer. Oncotarget, 2015, 6(34): 36884-36893.
19. Hinoi T, Okajima M, Shimomura M, et al. Effect of left colonic artery preservation on anastomotic leakage in laparoscopic anterior resection for middle and low rectal cancer. World J Surg, 2013, 37(12): 2935-2943.
20. 常文举, 任黎, 许剑民. 2019年结直肠癌肝转移诊疗指南最新解读. 中国普外基础与临床杂志, 2019, 26(8): 907-911.
21. Deng Y, Chi P, Lan P, et al. Modified FOLFOX6 with or without radiation versus fluorouracil and leucovorin with radiation in neoadjuvant treatment of locally advanced rectal cancer: initial results of the Chinese FOWARC multicenter, open-label, randomized three-arm phase Ⅲ trial. J Clin Oncol, 2016, 34(27): 3300-3307.
22. Katayama H, Kurokawa Y, Nakamura K, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today, 2016, 46(6): 668-685.
23. 李子禹, 吴舟桥, 季加孚. 中国胃肠肿瘤外科术后并发症诊断登记规范专家共识(2018版). 中国实用外科杂志, 2018, 38(6): 589-595.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application research of sidestream dark field imaging technology in laparoscopic anterior resection of rectal cancer

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