Impact of indocyanine green fluorescence angiography on anastomotic leak in ovarian cancer cytoreductive surgery: a retrospective cohort study

Objective: To evaluate whether the use of indocyanine green fluorescence angiography was associated with a reduced risk of anastomotic leak after rectosigmoid resection in patients undergoing cytoreductive surgery for FIGO stage III–IV epithelial ovarian cancer. Methods: We performed a single-center retrospective cohort study of consecutive patients with stage III-IV epithelial ovarian, fallopian tube, or primary peritoneal cancer who underwent primary or interval cytoreductive surgery with rectosigmoid resection and anastomosis between January 2009 and December 2023. Patients treated from 2020-2023 underwent indocyanine green fluorescence angiography in addition to conventional perfusion assessment; those treated from 2009-2019 underwent conventional perfusion assessment (visual inspection of anastomotic tension and intraoperative air leak testing) alone. Multivariable logistic regressions were used to identify predictors of anastomotic leak. Results: Among 795 patients included, 556 (70.0%) underwent surgery before indocyanine green fluorescence angiography adoption and 239 (30.0%) after. Overall, 45 patients (5.7%) developed an anastomotic leak. Leak rates were significantly lower in the ICG group compared with the no–ICG group (2.5% vs 7.0%; P = .01). In multivariable analysis, use of indocyanine green fluorescence angiography was independently associated with a lower risk of anastomotic leak (odds ratio [OR], 0.37; 95% CI, 0.14–0.83; P = .03). Conclusion: In this retrospective cohort study of patients undergoing cytoreductive surgery for stage III–IV ovarian cancer, use of indocyanine green fluorescence angiography was independently associated with a significantly lower rate of rectosigmoid anastomotic leak compared to conventional assessment. These findings support the use of indocyanine green fluorescence angiography as an adjunct intraoperative tool to reduce the risk of anastomotic leak.