A study evaluated whether quantitative analysis of indocyanine green (ICG) fluorescence imaging could improve assessment of bowel perfusion during colorectal cancer surgery and reduce the risk of anastomotic leakage, a serious postoperative complication caused by poor blood supply at the surgical connection site.
The study included 80 patients and used near-infrared imaging to assess tissue blood flow in real time. In 15% of cases, surgeons identified poor perfusion during the operation and changed the planned anastomosis site to better-perfused tissue. As a result, only one patient (1.2%) developed anastomotic leakage within 30 days.
Further software analysis showed that objective fluorescence measurements could better identify at-risk tissue than visual inspection alone. Two key indicators stood out: a very short fluorescence onset time and a low plateau intensity ratio, both linked to impaired microvascular function even when tissue initially appeared well perfused.
The findings suggest that relying only on brightness during ICG imaging is not enough. A more detailed, time-based analysis of fluorescence patterns may help surgeons make more accurate decisions and prevent postoperative complications.