Perfusion Assessment in Laparoscopic Left-Sided/Anterior Resection (PILLAR II): A Multi-Institutional Study - 14/12/14
Abstract |
Background |
Our primary objective was to demonstrate the utility and feasibility of the intraoperative assessment of colon and rectal perfusion using fluorescence angiography (FA) during left-sided colectomy and anterior resection. Anastomotic leak (AL) after colorectal resection increases morbidity, mortality, and, in cancer cases, recurrence rates. Inadequate perfusion may contribute to AL. The PINPOINT Endoscopic Fluorescence Imaging System allows for intraoperative assessment of anastomotic perfusion.
Study Design |
This is a prospective, multicenter, open-label, clinical trial that assessed the feasibility and utility of FA for intraoperative perfusion assessment during left-sided colectomy and anterior resection at 11 centers in the United States.
Results |
A total of 147 patients were enrolled, of whom 139 were eligible for analysis. Diverticulitis (44%), rectal cancer (25%), and colon cancer (21%) were the most prevalent indications for surgery. The mean level of anastomosis was 10 ± 4 cm from the anal verge. Splenic-flexure mobilization was performed in 81% and high ligation of the inferior mesenteric artery in 61.9% of patients. There was a 99% success rate for FA, and FA changed surgical plans in 11 (8%) patients, with the majority of changes occurring at the time of transection of the proximal margin (7%). Overall morbidity rates were 17%. The anastomotic leak rate was 1.4% (n = 2). There were no anastomotic leaks in the 11 patients who had a change in surgical plan based on intraoperative perfusion assessment with FA.
Conclusions |
PINPOINT is a safe and feasible tool for intraoperative assessment of tissue perfusion during colorectal resection. There were no anastomotic leaks in patients in whom the anastomosis was revised based on inadequate perfusion with FA.
Le texte complet de cet article est disponible en PDF.Abbreviations and Acronyms : FA, ICG, IMA, NIR, VIS
Plan
| Disclosure Information: Drs Wexner, McLemore, Sherwinter, and Stamos are paid consultants and speakers for Novadaq Technologies Inc. The study is fully funded by Novadaq Technologies Inc. All other authors have nothing to disclose. |
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| Disclosures outside the scope of the current work: Dr Lee provided expert testimony for Covidien and is paid as a speaker by Applied Medical; Dr McLemore is a paid consultant for Covidien and Intuitive Surgical, received grants from Applied Medical, Covidien, and Stryker, received pay as a speaker for Applied Medical, Ethicon EndoSurgery, Cubist, Genomic Health, Covidien, and Novadaq, and owns stock in Cubist. |
Vol 220 - N° 1
P. 82 - janvier 2015 Retour au numéro
Article précédent
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