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Anastomotic leakage (AL) represents one of the most relevant complications of colorectal cancer surgery. The aim of this study was to evaluate the utility of intraoperative indocyanine green (ICG) fluorescence imaging in the prevention of AL during laparoscopic colorectal surgery. Methods. We retrospectively analyzed 272 patients who underwent rectal and left colon surgery, consecutively enrolled between 2015 and 2019. Due to the heterogeneity of our groups, a propensity score matching (PSM) was performed with a 1:1 PSM cohort. Results. AL occurred in 36 (13.2%) patients. One hundred seventy-seven (65%) of them underwent an intraoperatory ICG test (ICG-group), whereas 95 patients (35%) did not receive the intraoperatory ICG test (no-ICG group). AL occurred in 10.8% of ICG group patients and in 17.8% of no-ICG group patients ( P = 0.07). The ICG group registered significantly less type B and type C fistulas than the no-ICG group (57.9 vs 88.2%; P = .043). After PSM, the overall AL rate was less in the ICG group than the no-ICG group (9.3% vs 16%; P = 0.058), while type B and type C fistulas occurred in 5.48% in the ICG group vs 13.70% in the no-ICG group ( P = 0.09). Univariate analysis demonstrated a protective effect of intraoperative ICG imaging against AL occurrence (odds ratio (OR: 0.66)). Conclusions. Hypoperfusion is a well-recognized cause of AL. The ICG assessment of colic vascularization is a simple, inexpensive, and side effects free method, which can sensibly reduce both overall AL and type B and type C fistulas when routinely used.

Background: The dysbiosis is defined as a disturbed symbiotic relationship between microbiota and the host and can cause a pro-inflammatory imbalance impairing the healing process at anastomotic level. The aim of this study is to detect, in fecal samples collected in the preoperative time, a peculiar microbiota composition that could predict the onset of colorectal anastomotic leakage., Materials and Methods: We compared gut microbiota of healthy patients (Group A) and patients with colorectal cancer eligible for surgery (Group B). Group B was divided into patients who developed anastomotic leak (Group BL) and patients who had uneventful recovery (Group BNL). Stool samples were collected before surgery and after neoadjuvant treatment., Results: We analyzed stool samples from 48 patients, 27 belonging to Group A and 21 to Group B. In Group B, five patients developed anastomotic leakage (Group BL). Compared to healthy subjects, Group B showed a moderate increase of Bacteroidetes and Proteobacteria, a moderate reduction of Firmicutes and Actinobacteria, and a statistically significant reduction of Faecalibacterium prausnitzii. Group BL patients showed an array of bacterial species which promoted dysbiosis, such as Acinetobacter lwoffii and Hafnia alvei. Group BNL patients showed that bacterial species like Faecalibacterium prausnitzii and Barnesiella intestinihominis have a protective function., Conclusions: The bacterial flora in subjects with colorectal cancer is statistically different compared to healthy patients. The presence of preoperative aggressive bacteria and the lack of protective strains has strengthened the hypothesis that a peculiar microbiota composition could represent a risk factor for the occurrence of anastomotic leakage.

Anastomotic leak (AL) is one of the worst complications of rectal anterior resection (RAR) and its incidence varies according to the anatomical site, increasing in lower anastomoses. Many etiological factors have been evaluated and most of these are related to bowel perfusion. Indocyanine green-enhanced fluorangiography (ICGf) has been proposed to help surgeons assess colonic perfusion with higher reliability than subjective clinical judgment. The aim of the study was to evaluate the efficacy of this tool in patients subjected to elective laparoscopic RAR for extraperitoneal rectal cancer. All the patients subjected to elective laparoscopic RAR for extraperitoneal rectal cancer between May 2015 and January 2017 were considered. In all of them, ICGf was performed to evaluate bowel perfusion. The control group included an equal number of patients subjected to the same procedure from January 2014 to April 2015, before the start of routine use of this tool at our institution. The endpoint of the study was to compare the incidence of AL between the two groups. A total of 33 patients were included in both groups. Relying on fluorescence intensity in the indocyanine green (ICG) group, we changed the level of resection in 6/33 patients (18.2%). An AL developed in 2/33 patients (6%) in the ICG group versus in 7/33 patients (21.2%) in the control group. The routine use of this technique may help surgeons in selecting the best level of proximal bowel resection during RAR.