Imaging Cuts Anastomotic Leakage in Rectal Cancer Surgery Imaging Cuts Anastomotic Leakage in Rectal Cancer Surgery

The study was published on as a preprint and has not yet been peer reviewed.

Key Takeaway

Why This Matters

  • Anastomotic leakage is a critical complication of colorectal surgery, occurring in up to 28% of patients.

  • Previous reports have shown that ICG fluorescence imaging reduces the incidence of anastomotic leakage in colon resections by helping surgeons avoid anastomosing areas of poor perfusion.

  • The current findings suggest a similar benefit in laparoscopic rectal cancer surgery.

Study Design

  • In a retrospective investigation, researchers assessed outcomes in 73 patients who had laparoscopic low anterior or intersphincteric resections with ICG fluorescence angiography compared with 114 patients who had similar surgeries but without ICG imaging.

  • Imaging was done prior to transection of the proximal colon.

  • The indocyanine green dose used was 10 mg.

Key Results

  • Three patients receiving ICG imaging (4.1%) developed an anastomotic leakage vs 14 patients without imaging (12.3%).

  • On univariate analysis, forgoing ICG imaging was associated with a threefold greater incidence of anastomotic leakage (odds ratio, 3.3).

  • The planned transection line was changed in five patients receiving ICG (6.8%) to areas with better perfusion; none developed anastomotic leakage.


  • Selection bias may have occurred when choosing patients for imaging.

  • Blood perfusion in the distal rectum was not investigated and could have influenced anastomotic leakage incidence.


This is a summary of a preprint research study, “Indocyanine green fluorescence imaging during laparoscopic rectal cancer surgery could reduce the incidence of anastomotic leakage: A single institutional retrospective cohort study,” led by Akihiro Kondo of Kagawa University, Japan. The study has not been peer reviewed. The full text can be found at

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email:

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