The impact of near-infrared angiography and proctoscopy after rectosigmoid resection and anastomosis performed during surgeries for gynecologic malignancies Journal Article

   


Authors: Moukarzel, L. A.; Byrne, M. E.; Leiva, S.; Wu, M.; Zhou, Q. C.; Iasonos, A.; Abu-Rustum, N. R.; Sonoda, Y.; Gardner, G.; Leitao, M. M. Jr; Broach, V. A.; Chi, D. S.; Long Roche, K.; Zivanovic, O.
Article Title: The impact of near-infrared angiography and proctoscopy after rectosigmoid resection and anastomosis performed during surgeries for gynecologic malignancies
Abstract: Objectives: Reducing anastomotic leak rates after rectosigmoid resection and anastomosis is a priority in patients undergoing gynecologic oncology surgery. Therefore, we investigated the implications of performing near-infrared angiography (NIR) via proctoscopy to assess anastomotic perfusion at the time of rectosigmoid resection and anastomosis. Methods: We identified all patients who underwent rectosigmoid resection and anastomosis for a gynecologic malignancy between January 1, 2013 and December 31, 2018. NIR proctoscopy was assessed via the PINPOINT Endoscopic Imaging System (Stryker). Results: A total of 410 patients were identified, among whom NIR was utilized in 133 (32.4%). There were no statistically significant differences in age, race, BMI, type of malignancy, surgery, histology, FIGO stage, hypertension, diabetes, or preoperative chemotherapy between NIR and non-NIR groups. All cases of rectosigmoid resection underwent stapled anastomosis. The anastomotic leak rate was 2/133 (1.5%) in the NIR cohort compared with 13/277 (4.7%) in the non-NIR cohort (p = 0.16). Diverting ostomy was performed in 9/133 (6.8%) NIR and 53/277 (19.9%) non-NIR patients (p < 0.001). Postoperative abscesses occurred in 8/133 (6.0%) NIR and 44/277 (15.9%) non-NIR patients (p = 0.004). The NIR cohort had significantly fewer post-operative interventional procedures (12/133, 9.0% NIR vs. 55/277, 19.9% non-NIR, p = 0.006) and significantly fewer 30-day readmissions (14/133, 10.5% NIR vs. 61/277, 22% non-NIR, p = 0.004). Conclusions: NIR proctoscopy is a safe tool for assessing anastomotic rectal perfusion after rectosigmoid resection and anastomosis, with a low anastomotic leak rate of 1.5%. Its potential usefulness should be evaluated in randomized trials in patients undergoing gynecologic cancer surgery. © 2020 Elsevier Inc.
Keywords: adult; controlled study; aged; antibiotic therapy; cancer surgery; major clinical study; end to end anastomosis; ovary cancer; peritoneum cancer; interventional radiology; colon resection; hospital readmission; uterine tube carcinoma; uterus cancer; angiography; uterus carcinoma; anastomosis leakage; female genital tract cancer; pelvis abscess; international federation of gynecology and obstetrics; rectoscopy; outcome variable; rectosigmoid resection; proctoscopy; human; female; priority journal; article; anastomotic leaks; gynecological malignancies; near-infrared angiography; exposure variable; near infrared angiography
Journal Title: Gynecologic Oncology
Volume: 158
Issue: 2
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2020-08-01
Start Page: 397
End Page: 401
Language: English
DOI: 10.1016/j.ygyno.2020.05.022
PUBMED: 32460995
PROVIDER: scopus
PMCID: PMC7693678
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85085179332&doi=10.1016%2fj.ygyno.2020.05.022&partnerID=40&md5=4d4fd9c20458c97e4e029dcfc2f5d198
Notes: Article -- Export Date: 1 September 2020 -- Source: Scopus
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MSK Authors
  1. Ginger J Gardner
    270 Gardner
  2. Dennis S Chi
    707 Chi
  3. Yukio Sonoda
    472 Sonoda
  4. Mario Leitao
    575 Leitao
  5. Nadeem Abu-Rustum
    888 Abu-Rustum
  6. Oliver Zivanovic
    291 Zivanovic
  7. Alexia Elia Iasonos
    362 Iasonos
  8. Kara Long Roche
    247 Long Roche
  9. Vance Andrew Broach
    115 Broach
  10. Lea Moukarzel
    40 Moukarzel
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