[A Case of Rectal Cancer Where the Intestinal Separation Line Was Significantly Altered by the Implementation of...

Area of Science:

• Surgical Oncology
• Gastroenterology
• Medical Imaging

Background:

• Anastomotic insufficiency is a significant complication following rectal surgery.
• Indocyanine green (ICG) fluorescence imaging offers a method to assess tissue perfusion.
• Evaluating blood flow in rectal stumps is crucial for surgical success.

Purpose of the Study:

• To evaluate the utility of ICG fluorescence imaging in guiding mesenteric division during laparoscopic low anterior resection for rectal cancer.
• To assess the prevention of anastomotic insufficiency using ICG-guided blood flow evaluation.

Main Methods:

• Laparoscopic low anterior resection for rectal cancer in an 83-year-old male.
• Extracorporeal oral-mesenteric division guided by ICG fluorescence imaging.
• Identification of ICG blood flow boundary for precise mesenteric division.

Main Results:

• ICG fluorescence imaging identified a clear blood flow boundary 25 cm from the initial division site.
• Mesenteric division was successfully performed at the determined ICG blood flow boundary.
• The patient experienced a favorable postoperative course with no anastomotic insufficiency.
• The patient remained recurrence-free 1 year after surgery.

Conclusions:

• ICG fluorescence imaging is a valuable tool for evaluating blood flow in rectal stumps.
• This technique aids in preventing anastomotic insufficiency in rectal cancer surgery.
• The case demonstrates the meaningful outcomes achievable with ICG-guided mesenteric division, even with varied reports.