Effectiveness of Blood Perfusion Assessment by Indocyanine Green Fluorescence Angiography in the Prevention of Anastomotic Leakage after Rectal Cancer Surgery in Japan: A Retrospective Study Using the Diagnosis Procedure Combination Database

Journal of the Anus, Rectum and Colon · Published 2026-07-24 · DOI 10.23922/jarc.2026-014

Free full text

Authors (11)

Takao Amaike, Makoto Okawara, Yasuki Akiyama, Jun Nagata, Kensuke Nitta, Masumi Yamauchi, Yoshihisa Fujino, Kazunori Shibao, Kiyohide Fushimi, Shinya Matsuda, Keiji Hirata

Abstract

Background: Several studies have reported the potential effectiveness of indocyanine green fluorescence angiography (ICG-FA) for preventing anastomotic leakage (AL) in rectal cancer surgery; however, its clinical benefit remains uncertain. The purpose of this study was to investigate the effectiveness of ICG-FA in rectal cancer surgery in Japan using real-world data. Methods: We retrieved data from the Diagnosis Procedure Combination database in Japan for rectal cancer surgeries between April 2018 and March 2022. A total of 68,022 cases were registered, and 55,299 eligible patients were analyzed. Using a two-level structure of nested individuals from 1,057 hospitals, we applied multilevel logistic regression. Results: A total of 40,013 laparoscopic (72.4%), 7,464 robotic (13.5%), and 7,822 open (14.1%) operations were performed. The rate of AL was 4.3% in the ICG-FA group and 5.1% in the non-ICG-FA group. After adjustment for patient- and hospital-level factors, ICG-FA was associated with a lower risk of AL (OR 0.87, 95% CI 0.76–1.00, p = 0.043); however, after additional adjustment for fiscal year, the association was no longer statistically significant (OR 0.91, 95% CI 0.79–1.04, p = 0.167). Conclusions: ICG-FA may be associated with a lower risk of AL after rectal cancer surgery in real-world settings, although the benefit was not statistically significant after additional adjustment for fiscal year.

Abstract from DOAJ. Public domain (CC0 1.0).

Read the article at the publisher →

Publication details

Year
2026

Citation

Amaike, T., Okawara, M., Akiyama, Y., et al. (2026). Effectiveness of Blood Perfusion Assessment by Indocyanine Green Fluorescence Angiography in the Prevention of Anastomotic Leakage after Rectal Cancer Surgery in Japan: A Retrospective Study Using the Diagnosis Procedure Combination Database. Journal of the Anus, Rectum and Colon. https://doi.org/10.23922/jarc.2026-014

Related articles