Use of Indocyanine Green Fluorescence Angiography to Assess Bowel Anastomosis in Ovarian Cancer Surgery

Abstract

Background/Aim: The aim of this study was to investigate the efficacy of indocyanine green (ICG) fluorescence angiography in preventing anastomotic leaks and reducing the need for ostomies during cytoreductive surgery in ovarian cancer. Patients and Methods: This was a retrospective study of patients with 2014 International Federation of Obstetrics and Gynecology stage IIB-IVB ovarian cancer requiring a bowel resection during primary or secondary cytoreductive surgery at our institution between July 2021 to April 2023. Rates of ostomy performance and anastomotic leak were assessed in the ICG angiography group and the non-ICG angiography group. Frequency distributions between categorical variables were compared using Fisher's exact or Chi-squared test. Wilcoxon rank-sum test and t-test were used to compare continuous variables. Results: During the study period, we reviewed the data of 59 consecutive patients with ovarian cancer with bowel resection; in 30 (50.85%) patients, bowel anastomosis was assessed using ICG angiography and in 29 (49.15%) patients, bowel anastomosis was not assessed using ICG angiography. Anastomotic leak rate was found to be 6.9% (n=2) in the non-ICG angiography group, and 3.33% in the ICG angiography group (n=1) (p=0.612). More diverting ostomies were performed in the non-ICG angiography group (n=6, 20.69%) compared to the ICG angiography group in which no ostomies were performed (p=0.011). Conclusion: ICG angiography is not associated with a decrease in anastomotic leak rates, but it may avoid ostomy formation.