Can Indocyanine Green Fluorescence Imaging Help Prevent Colorectal Anastomotic Leakage?

Rinne JKA, Huhta H, Pinta T, et al. Indocyanine Green Fluorescence Imaging in Prevention of Colorectal Anastomotic Leakage: A Randomized Clinical Trial. JAMA Surg. 2025; in press.

Wilson MZ, Stewart DB. Indocyanine Green Fluorescence for Colectomy—Better than the Naked Eye? JAMA Surg. 2025; in press.

Assessment of risk for anastomotic leakage during colorectal procedures is challenging. Indocyanine green (ICG) fluorescence imaging has been suggested for evaluation of tissue perfusion at the anastomotic site.

For this randomized, prospective trial, patients undergoing laparoscopic colorectal procedures (excluding low anterior resection) were recruited during preoperative visits (n = 1,136). Patients were randomized to receive intravenous ICG prior to and after anastomosis formation; tissue perfusion was assessed with a near-infrared camera. Risk for anastomotic leakage was determined by surgeon assessment in the control group.

The data analysis showed that there was no significant difference in rates of anastomotic leakage in the two comparison groups. Signal intensity or time to maximal signal intensity were not predictive of anastomotic leakage in the ICG patient group.

For left-sided operations, the lower leak rate in the ICG group nearly reached statistical significance; the authors noted that this finding suggested potential benefit for ICG leak assessment in left-sided colorectal procedures.

In the editorial that accompanied the article, Wilson and Stewart noted that the ideal test to determine risk of anastomotic leakage should reassure the surgeon prior to leaving the operating room. The value of ICG and other assessments should be determined with this goal in mind.