Colorectal Surgery

SPY IMAGING IN COLORECTAL SURGERY

Colorectal cancer is the third most common cancer diagnosed in men and women in the United States.  The American Cancer Society estimates that in 2016, more than 130,000 new cases of colorectal cancer will be reported and that colorectal cancer will cause approximately 49, 000 deaths.

Open or laparoscopic surgery is a common treatment for rectal cancer. The type of surgery used depends on the extent of the cancer. Some colorectal cancers in the upper part of the rectum (close to where it connects with the colon) can be removed by a surgical technique called low anterior resection (LAR). In this operation, the part of the rectum containing the tumor and a margin of normal tissue on either side of the cancer, along with nearby lymph nodes and other tissues around the rectum are removed. The colon is then attached to the remaining part of the rectum (either right away or at a later time). If at a later time a temporary ileostomy is made to give the colorectal area some time to heal from treatment before food matter moves through it again. The ileostomy can typically be reversed (the intestines reconnected) within a few weeks.

Major postoperative complications following colorectal surgery include wound infection, ileus, bleeding and anastomotic leakage. Anastomotic leakage is one of the most serious complications specific to colorectal surgery and its occurrence ranges from in 2.9% to as high as 15.3% of all cases. At least one third of the mortality after colorectal surgery is attributed to leaks.1 Anastomotic leaks also result in increased care costs. Vonlanthen et al., studied 389 patients undergoing colorectal surgery and reported that mean hospital costs for patients with complications such as anastomotic leak requiring surgical intervention could be as high as $95,000 compared to $26,000 for those without complications.

The use of NOVADAQ’s endoscopic version of SPY Fluorescence Imaging technology called PINPOINT has been shown to be of great value to surgeons performing laparoscopic colorectal surgery. PINPOINT allows surgeons to visually asses the quality of blood flow in colon and rectal tissue, which is commonly known as tissue perfusion. Understanding the quality of perfusion can assist surgeons in determining healthy versus non-healthy tissue and the level at which they wish to make their incision in the colon.

In January 2015, Jafari et al., reported on 139 patients enrolled in the PILLAR II trial. PINPOINT fluorescence imaging was successfully performed in 99% of patients and the use of PINPOINT resulted in changes in surgical plans in 11 (8%) patients, with the majority of changes occurring at the time of transection. Anastomotic leaks occurred in two patients (1.4%). There were no anastomotic leaks in the 11 patients who had a change in surgical plan based on intraoperative perfusion assessment with PINPOINT.

CLINICAL REFERENCES

1.Kirchhoff et al. Complications in Colorectal Surgery: Risk Factors and Preventive Strategies. Patient Safety in Surgery Journal, March 2010.

2. Vonlathen R. et al, The impact of complications on costs of major surgical procedures: a cost   analysis of 1200  patients. Ann Surg. 2011 Dec;254(6):907-13.

3. Jafari MD, Wexner SD, Martz JE, McLemore EC, Margolin DA, Sherwinter, DA, Lee SW, Senagore AJ, Phelan MJ, Stamos MJ. Perfusion Assessment in Laparoscopic Left Sided/ Anterior Resection (PILLAR II): A Multi-Institutional Study. JACS. Vol. 220, No. 1, January 2015.