# Deep impact analysis of surgical strategy changes guided by indocyanine green fluorescence angiography in laparoscopic low anterior resection for rectal cancer

## TL;DR

This study shows that using ICG fluorescence angiography during rectal cancer surgery helps surgeons adjust plans for better outcomes in high-risk patients.

## Contribution

The study identifies specific patient factors that influence surgical plan changes based on ICG fluorescence and demonstrates improved functional outcomes.

## Key findings

- Patients with perfusion risk factors had higher anastomoses after surgical plan changes.
- These patients also showed better bowel function with lower LARS scores.
- Anastomotic leakage rates were similar between groups.

## Abstract

This study investigated the patient factors leading to ICG fluorescence angiography (ICG–FI)–guided surgical plan changes during rectal cancer surgery and evaluated the impact of these changes on anastomotic height and postoperative bowel function.

In a retrospective analysis of 302 patients undergoing laparoscopic low anterior resection, we compared 28 patients requiring perfusion-based plan changes (Change group) to 274 without changes (No-Change group). We analyzed demographics, anastomotic height, and 6-month LARS scores.

The Change group had significantly older age, higher BMI, more neoadjuvant therapy, and lower tumor height. Their final anastomoses were higher (8.0 vs. 6.0 cm, p < 0.001). This group also had better bowel function, with lower LARS scores (18 vs. 25, p = 0.007) and fewer major LARS cases (14.3% vs. 32.1%, p = 0.041). Anastomotic leakage rates were similar.

ICG–FI identifies patients with perfusion risk factors (age, obesity, neoadjuvant therapy, low tumors) who benefit from surgical plan modification. Guiding the proximal resection margin based on ICG assessment to create a higher, well-perfused anastomosis significantly improves functional outcomes, underscoring its role in personalized surgery.

The study was registered in the clinical trials registry with registration number NCT06270745.