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Surgeons are increasingly adopting ICG fluorescence perfusion analysis to assess tissue viability during colorectal cancer resections. This quantitative approach helps identify intraoperative hypoperfusion, which is a major risk factor for postoperative anastomotic leaks. By measuring specific parameters, clinicians can make data-driven decisions regarding the safety of the surgical site. Consequently, these metrics provide a higher level of accuracy compared to subjective visual assessments.
Traditionally, surgeons relied on qualitative visual inspections to evaluate blood flow. However, quantitative markers provide objective data that reduce clinical uncertainty. Specifically, recent research highlights latency and the plateau intensity ratio (PIR) as critical indicators. Latency measures the timing of early arterial inflow kinetics, showing how quickly the dye reaches the tissue. In contrast, PIR captures outflow characteristics related to microvascular and venous integrity. Furthermore, combining these two metrics significantly improves the detection of blood flow issues. Therefore, this dual-marker approach supports more reliable anastomotic site selection.
The study of eighty patients revealed that latency was markedly shorter in cases of hypoperfusion. Specifically, hypoperfused cases showed a median latency of 5.5 seconds compared to 20 seconds in healthy tissues. Moreover, the PIR was notably decreased in compromised segments. These data points allow surgeons to relocate the anastomosis site intraoperatively before a leak occurs. Using such objective markers leads to enhanced patient safety and better overall surgical outcomes.
The study identifies latency and plateau intensity ratio (PIR) as the primary quantitative markers. Latency reflects the speed of arterial inflow, while PIR indicates the health of the microvasculature and venous outflow.
By providing objective measurements of blood flow, it allows surgeons to identify poorly perfused tissue that may look healthy to the naked eye. This enables them to relocate the surgical site, reducing the risk of anastomotic leaks.
Yes, while visual inspection is common, quantitative analysis provides specific numerical data like latency and PIR. These metrics have demonstrated high specificity, offering a more reliable basis for surgical decisions.
Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional regarding any medical condition or treatment. Refer to the latest local and national guidelines for clinical practice.
References
Daniluk-Marsy P et al. Decreased fluorescence latency and plateau intensity ratio as predictive markers of intraoperative hypoperfusion: quantitative indocyanine green perfusion analysis in colorectal cancer surgery. Ann Coloproctol. 2026 May 27. doi: 10.3393/ac.2025.01298.0185. PMID: 42192239.
Jafari MD et al. Perfusion assessment in laparoscopic colorectal surgery using indocyanine green. Surg Endosc. 2015.
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