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:
Notes: Article -- Export Date: 1 September 2020 -- Source: Scopus
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MSK Authors
  1. Ginger J Gardner
    204 Gardner
  2. Dennis S Chi
    589 Chi
  3. Yukio Sonoda
    365 Sonoda
  4. Mario Leitao
    434 Leitao
  5. Oliver Zivanovic
    207 Zivanovic
  6. Alexia Elia Iasonos
    254 Iasonos
  7. Kara Christine Long
    138 Long
  8. Vance Andrew Broach
    50 Broach