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Intraoperative left-sided colorectal anastomotic testing in clinical practice: a multi-treatment machine-learning analysis of the iCral3 prospective cohort

  • 期刊论文

  • 发表日期：

    2024年5月20日

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  • Marco Catarci,
  • Stefano Guadagni,
  • Francesco Masedu,
  • Gianluca Guercioni,
  • Giacomo Ruffo,
  • Massimo Giuseppe Viola,
  • Felice Borghi,
  • Marco Scatizzi,
  • Alberto Patriti,
  • Gian Luca Baiocchi,
  • Paolo Ciano,
  • Michele Benedetti,
  • Leonardo Antonio Montemurro,
  • Matteo Di Carlo,
  • Marco Clementi,
  • Simone Cicconi,
  • Elisa Bertocchi,
  • Gaia Masini,
  • Amedeo Altamura,
  • Francesco Rubichi,
  • Marco Migliore,
  • Lorenzo Pandolfini,
  • Alessandro Falsetto,
  • Marcella Lodovica Ricci,
  • Sarah Molfino,
  • Gianluca Garulli,
  • Daniele Parlanti,
  • Gabriele Vago,
  • Felice Pirozzi,
  • Antonio Sciuto,
  • Paolo Delrio,
  • Ugo Pace,
  • Andrea Fares Bucci,
  • Raffaele De Luca,
  • Michele Simone,
  • Gianandrea Baldazzi,
  • Diletta Cassini,
  • Ferdinando Ficari,
  • Francesco Giudici,
  • Fabio Cianchi,
  • Walter Siquini,
  • Alessandro Cardinali,
  • Stefano D’Ugo,
  • Marcello Spampinato,
  • Stefano Scabini,
  • Alessandra Aprile,
  • Domenico Soriero,
  • Marco Caricato,
  • Gabriella Teresa Capolupo,
  • Giusto Pignata,
  • Jacopo Andreuccetti,
  • Ilaria Canfora,
  • Andrea Liverani,
  • Giuseppe Lamacchia,
  • Claudia Franceschilli,
  • Roberto Campagnacci,
  • Angela Maurizi,
  • Pierluigi Marini,
  • Grazia Maria Attinà,
  • Ugo Elmore,
  • Francesco Puccetti,
  • Francesco Corcione,
  • Umberto Bracale,
  • Roberto Peltrini,
  • Roberto Santoro,
  • Pietro Amodio,
  • Massimo Carlini,
  • Domenico Spoletini,
  • Rosa Marcellinaro,
  • Antonio Giuliani,
  • Giovanni Del Vecchio,
  • Mario Sorrentino,
  • Massimo Stefanoni,
  • Giovanni Ferrari,
  • Pietro Carnevali,
  • Alberto Di Leo,
  • Lorenzo Crepaz,
  • Augusto Verzelli,
  • Andrea Budassi,
  • Giuseppe Sica,
  • Giulia Bagaglini,
  • Stefano Rausei,
  • Silvia Tenconi,
  • Davide Cavaliere,
  • Leonardo Solaini,
  • Giorgio Ercolani,
  • Marco Milone,
  • Giovanni Domenico De Palma,
  • Giovanni Ciaccio,
  • Paolo Locurto,
  • Giovanni Domenico Tebala,
  • Antonio Di Cintio,
  • Luigi Boni,
  • Ludovica Baldari,
  • Elisa Cassinotti,
  • Stefano Mancini,
  • Andrea Sagnotta,
  • Mario Guerrieri,
  • Monica Ortenzi,
  • Roberto Persiani,
  • Alberto Biondi,
  • Andrea Lucchi,
  • Giulia Vitali,
  • Dario Parini,
  • Maurizio De Luca,
  • Antonino Spinelli,
  • Francesco Carrano,
  • Michele Genna,
  • Francesca Fior,
  • Vincenzo Bottino,
  • Antonio Ferronetti,
  • Andrea Coratti,
  • Giuseppe Giuliani,
  • Roberto Benigni,
  • Dario Scala,
  • Battistino Puppio,
  • Alessio Vagliasindi,
  • Andrea Muratore,
  • Patrizia Marsanic,
  • Nicoletta Sveva Pipitone Federico,
  • Maurizio Pavanello,
  • Carlo Di Marco,
  • Umberto Rivolta,
  • Camillo Leonardo Bertoglio,
  • Micaela Piccoli,
  • Francesca Pecchini,
  • Carlo Talarico,
  • Vincenzo Greco,
  • Alessandro Carrara,
  • Michele Motter,
  • Giuseppe Tirone,
  • Mauro Totis,
  • Nicolò Tamini,
  • Franco Roviello,
  • Riccardo Piagnerelli,
  • Alessandro Anastasi,
  • Giuseppe Canonico,
  • Giuseppe Maria Ettorre,
  • Marco Colasanti,
  • Mauro Montuori,
  • Enrico Pinotti,
  • Pierpaolo Mariani,
  • Roberta Carminati,
  • Nicolò de Manzini,
  • Edoardo Osenda,
  • Annibale Donini,
  • Luigina Graziosi,
  • Mariano Fortunato Armellino,
  • Ciro De Martino,
  • Lucio Taglietti,
  • Arianna Birindelli,
  • Gabriele Anania,
  • Matteo Chiozza,
  • Mariantonietta Di Cosmo,
  • Daniele Zigiotto,
  • Carlo Vittorio Feo,
  • Fioralba Pindozzi,
  • Paolo Millo,
  • Manuela Grivon,
  • Corrado Pedrazzani,
  • Cristian Conti,
  • Silvio Guerriero,
  • Lorenzo Organetti,
  • Andrea Costanzi,
  • Michela Monteleone,
  • Nereo Vettoretto,
  • Emanuele Botteri,
  • Federico Marchesi,
  • Giorgio Dalmonte,
  • Massimo Basti,
  • Diletta Frazzini,
  • Graziano Longo,
  • Simone Santoni,
  • Moreno Cicetti,
  • Gabriele La Gioia

摘要

Background

Current evidence about intraoperative anastomotic testing after left-sided colorectal resections is still controversial. The aim of this study was to analyze the impact of Indocyanine Green fluorescent angiography (ICG-FA) and air-leak test (ALT) over standard assessment on anastomotic leakage (AL) rates according to surgeon’s perception of anastomosis perfusion and/or integrity in clinical practice.

Methods

A database of 2061 patients who underwent left-sided colorectal resections was selected from patients enrolled in a prospective multicenter study. It was retrospectively analyzed through a multi-treatment machine-learning model considering standard visual assessment (NW; No. = 899; 43.6%) as the reference treatment arm, compared to ICG-FA alone (WP; No. = 409; 19.8%), ALT alone (WI; No. = 420; 20.4%) or both (WPI; No. = 333; 16.2%). Twenty-four covariates potentially affecting the outcomes were included and balanced into the model within the subgroups. The primary endpoint was AL, the secondary endpoints were overall morbidity (OM), major morbidity (MM), reoperation for AL, and mortality. All the results were reported as odds ratio (OR) with 95% confidence intervals (95%CI).

Results

The WPI subgroup showed significantly higher AL risk (OR 1.91; 95% CI 1.02–3.59; p 0.043), MM risk (OR 2.35; 95% CI 1.39–3.97; p 0.001), and reoperation for AL risk (OR 2.44; 95% CI 1.12–5.31; p 0.025). No other significant differences were recorded.

Conclusions

This study showed that the surgeons’ perception of both anastomotic perfusion and integrity (WPI subgroup) was associated to a significantly higher risk of AL and related morbidity, notwithstanding the extensive use of both ICG-FA and ALT testing.