Evaluation of Colonic Perfusion by Indocyanine Green Angiography During Elective Colorectal Surgery: Randomized Controlled Trial

Status: Recruiting
Location: See location...
Intervention Type: Procedure
Study Type: Interventional
Study Phase: Not Applicable
SUMMARY

Despite advancements in technology and improved surgical techniques, the occurrence of anastomotic leakage (AL) after colorectal surgery remains between 4% and 30%. AL is a feared complication associated with significant morbidity and mortality in colorectal surgery, with its causes being multifaceted. Inadequate blood supply to the intestines is believed to be a major contributor to its development. Various methods have been proposed to objectively assess intestinal perfusion beyond the subjective evaluation done by surgeons during surgery. However, these methods face challenges such as poor reproducibility and high costs, limiting their routine use. In recent years, indocyanine green (ICG) angiography has emerged as a tool for assessing organ perfusion in various medical scenarios. However, only one randomized clinical trial has been conducted regarding its use in evaluating colorectal surgery outcomes, which found that while ICG angiography sometimes led to additional bowel resection, it didn't significantly reduce the rate of anastomotic leaks compared to conventional methods. This could be due to the trial's small sample size, potentially reducing its statistical power. This study aims to investigate whether ICG angiography can lower the rate of anastomotic leaks during laparoscopic colorectal cancer surgery, while also examining its impact on resection margins, perioperative morbidity, and mortality rates. A total of 561 subjects undergoing laparoscopic colorectal surgery for malignancy, will be randomized in 2 arms: A Study Group undergoing ICG angiography (i.e. colonic perfusion is intraoperatively assessed by ICG angiography and level of resection is selected based on the fluorescence) and a Control Group (i.e. resection is performed based on subjective judgment).

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Maximum Age: 85
Healthy Volunteers: f
View:

• Age: 18-85 years

• Malignant colorectal tumors

• Elective surgery

Locations
Other Locations
Italy
Lidia Castagneto Gissey
RECRUITING
Roma
Contact Information
Primary
Lidia Castagneto Gissey, MD, PhD
lidia.castagnetogissey@uniroma1.it
3403497741
Backup
Giovanni Casella, MD, PhD
giovanni.casella@uniroma1.it
Time Frame
Start Date: 2023-05-06
Estimated Completion Date: 2025-09-06
Participants
Target number of participants: 562
Treatments
Experimental: ICG angiography
luorescence angiography is utilized to assess colonic resection margins and colorectal anastomosis, aiming to evaluate colonic blood flow. If the assessment indicates insufficient perfusion at the resection margin, the colon is resected once more to ensure satisfactory blood flow.~luorescence angiography is utilized to assess colonic resection margins and colorectal anastomosis, aiming to evaluate colonic blood flow. If the assessment indicates insufficient perfusion at the resection margin, the colon is resected once more to ensure satisfactory blood flow.~Colonic resection margins and colorectal anastomosis are intraoperatively assessed using fluorescence angiography to evaluate colonic perfusion. If perfusion at resection margin is considered insufficient the colon is resected again in order to obtain adequate perfusion.
Active_comparator: No ICG angiography
Subjective visual measures are employed by the surgeon in order to determine anastomotic perfusion.
Related Therapeutic Areas
Sponsors
Collaborators: San Giovanni Addolorata Hospital, Nuovo Ospedale dei Castelli
Leads: University of Roma La Sapienza

This content was sourced from clinicaltrials.gov