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Perfusion Assessment in Left-Sided/Low Anterior Resection (PILLAR III): A Randomized, Controlled, Parallel,
Mehraneh D Jafari1, Alessio Pigazzi1, Elisabeth C McLemore2
1Department of Surgery, Division of Colorectal Surgery, University of California, Irvine, Orange, California.
Diseases of the Colon and Rectum
|April 19, 2021
Summary
Indocyanine green fluoroscopy (ICG-F) did not reduce anastomotic leak rates in low anterior resection compared to standard care. While visualization of perfusion was successful, routine ICG-F offers no evident clinical benefit in experienced hands.
Area of Science:
- Surgical Oncology
- Gastrointestinal Surgery
- Medical Imaging
Background:
- Early trials suggested indocyanine green fluoroscopy (ICG-F) improves anastomotic leak rates.
- Assessing anastomotic perfusion is crucial for preventing leaks after low anterior resection.
Purpose of the Study:
- To test the hypothesis that ICG-F to ensure anastomotic perfusion decreases anastomotic leak rates.
- To compare outcomes of standard perfusion evaluation versus ICG-F in low anterior resection.
Main Methods:
- A 1:1 randomized controlled parallel multicenter trial was planned.
- 347 patients undergoing low anterior resection (anastomosis within 10 cm of anal verge) were recruited.
- Patients received either standard perfusion evaluation or standard evaluation plus ICG-F.
Main Results:
- The study was stopped early due to low accrual, failing to reach the predetermined sample size.
- No significant difference in anastomotic leak rates (9.0% vs. 9.6%, p=0.37) was observed between groups.
- Postoperative abscess rates requiring intervention were also comparable (5.7% vs. 4.2%, p=0.75).
Conclusions:
- ICG-F allows successful visualization of tissue perfusion.
- However, this study found no significant difference in anastomotic leak rates compared to standard techniques.
- Routine use of ICG-F in experienced hands does not provide evident clinical benefit for low anterior resection.
