Quantitative Fluorescence Imaging of Perfusion-An Algorithm to Predict Anastomotic Leakage

Area of Science:

• Surgical oncology
• Medical imaging
• Gastrointestinal surgery

Background:

• Anastomotic leakage and strictures are significant complications after gastric surgery.
• Poor perfusion of the gastric fundus is a primary risk factor for these adverse outcomes.
• Intraoperative fluorescence imaging offers a potential method to assess tissue perfusion.

Purpose of the Study:

• To evaluate quantitative parameters derived from fluorescence imaging for assessing gastric tube perfusion.
• To correlate these perfusion parameters with patient outcomes, specifically anastomotic leakage.
• To establish reliable methods for quantifying fluorescence signals in surgical settings.

Main Methods:

• Quantitative analysis of fluorescence imaging data, including maximal intensity, mean slope, and influx timepoint.
• Comparison of perfusion parameters across four distinct areas of the gastric tube in 22 patients.
• Statistical analysis using repeated ANOVA to determine significant differences between perfusion areas.
• Correlation of quantitative perfusion parameters with patient outcomes, including anastomotic leakage.

Main Results:

• Significant differences (p < 0.0001) were observed in maximal intensity, mean slope, and influx timepoint between the gastric tube base and fundus.
• Patients who developed anastomotic leakage exhibited a mean slope near 0 in Location 4.
• A significantly greater distance of indocyanine green (ICG) demarcation to the fundus was noted in patients with anastomotic leakage (p < 0.0001).

Conclusions:

• Quantitative intraoperative perfusion imaging using fluorescence is feasible and provides valuable data.
• Quantification of fluorescence signals enables early risk stratification for gastric necrosis.
• This approach may help reduce the incidence of anastomotic leakage and improve surgical outcomes.