Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II)

A multi-institutional study

Mehraneh D. Jafari, Steven D. Wexner, Joseph E. Martz, Elisabeth C. McLemore, David A. Margolin, Danny A. Sherwinter, Sang W. Lee, Anthony J. Senagore, Michael J. Phelan, Michael J. Stamos

Research output: Contribution to journalArticle

133 Citations (Scopus)

Abstract

Background Our primary objective was to demonstrate the utility and feasibility of the intraoperative assessment of colon and rectal perfusion using fluorescence angiography (FA) during left-sided colectomy and anterior resection. Anastomotic leak (AL) after colorectal resection increases morbidity, mortality, and, in cancer cases, recurrence rates. Inadequate perfusion may contribute to AL. The PINPOINT Endoscopic Fluorescence Imaging System allows for intraoperative assessment of anastomotic perfusion.

Study Design This is a prospective, multicenter, open-label, clinical trial that assessed the feasibility and utility of FA for intraoperative perfusion assessment during left-sided colectomy and anterior resection at 11 centers in the United States.

Results A total of 147 patients were enrolled, of whom 139 were eligible for analysis. Diverticulitis (44%), rectal cancer (25%), and colon cancer (21%) were the most prevalent indications for surgery. The mean level of anastomosis was 10 ± 4 cm from the anal verge. Splenic-flexure mobilization was performed in 81% and high ligation of the inferior mesenteric artery in 61.9% of patients. There was a 99% success rate for FA, and FA changed surgical plans in 11 (8%) patients, with the majority of changes occurring at the time of transection of the proximal margin (7%). Overall morbidity rates were 17%. The anastomotic leak rate was 1.4% (n = 2). There were no anastomotic leaks in the 11 patients who had a change in surgical plan based on intraoperative perfusion assessment with FA.

Conclusions PINPOINT is a safe and feasible tool for intraoperative assessment of tissue perfusion during colorectal resection. There were no anastomotic leaks in patients in whom the anastomosis was revised based on inadequate perfusion with FA.

Original languageEnglish (US)
Pages (from-to)82-92.e1
JournalJournal of the American College of Surgeons
Volume220
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Fluorescein Angiography
Anastomotic Leak
Perfusion
Colectomy
Colonic Neoplasms
Inferior Mesenteric Artery
Morbidity
Transverse Colon
Diverticulitis
Optical Imaging
Rectal Neoplasms
Ligation
Colon
Clinical Trials
Recurrence
Mortality
Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Jafari, M. D., Wexner, S. D., Martz, J. E., McLemore, E. C., Margolin, D. A., Sherwinter, D. A., ... Stamos, M. J. (2015). Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): A multi-institutional study. Journal of the American College of Surgeons, 220(1), 82-92.e1. https://doi.org/10.1016/j.jamcollsurg.2014.09.015

Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II) : A multi-institutional study. / Jafari, Mehraneh D.; Wexner, Steven D.; Martz, Joseph E.; McLemore, Elisabeth C.; Margolin, David A.; Sherwinter, Danny A.; Lee, Sang W.; Senagore, Anthony J.; Phelan, Michael J.; Stamos, Michael J.

In: Journal of the American College of Surgeons, Vol. 220, No. 1, 01.01.2015, p. 82-92.e1.

Research output: Contribution to journalArticle

Jafari, MD, Wexner, SD, Martz, JE, McLemore, EC, Margolin, DA, Sherwinter, DA, Lee, SW, Senagore, AJ, Phelan, MJ & Stamos, MJ 2015, 'Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): A multi-institutional study', Journal of the American College of Surgeons, vol. 220, no. 1, pp. 82-92.e1. https://doi.org/10.1016/j.jamcollsurg.2014.09.015
Jafari, Mehraneh D. ; Wexner, Steven D. ; Martz, Joseph E. ; McLemore, Elisabeth C. ; Margolin, David A. ; Sherwinter, Danny A. ; Lee, Sang W. ; Senagore, Anthony J. ; Phelan, Michael J. ; Stamos, Michael J. / Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II) : A multi-institutional study. In: Journal of the American College of Surgeons. 2015 ; Vol. 220, No. 1. pp. 82-92.e1.
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abstract = "Background Our primary objective was to demonstrate the utility and feasibility of the intraoperative assessment of colon and rectal perfusion using fluorescence angiography (FA) during left-sided colectomy and anterior resection. Anastomotic leak (AL) after colorectal resection increases morbidity, mortality, and, in cancer cases, recurrence rates. Inadequate perfusion may contribute to AL. The PINPOINT Endoscopic Fluorescence Imaging System allows for intraoperative assessment of anastomotic perfusion.Study Design This is a prospective, multicenter, open-label, clinical trial that assessed the feasibility and utility of FA for intraoperative perfusion assessment during left-sided colectomy and anterior resection at 11 centers in the United States.Results A total of 147 patients were enrolled, of whom 139 were eligible for analysis. Diverticulitis (44{\%}), rectal cancer (25{\%}), and colon cancer (21{\%}) were the most prevalent indications for surgery. The mean level of anastomosis was 10 ± 4 cm from the anal verge. Splenic-flexure mobilization was performed in 81{\%} and high ligation of the inferior mesenteric artery in 61.9{\%} of patients. There was a 99{\%} success rate for FA, and FA changed surgical plans in 11 (8{\%}) patients, with the majority of changes occurring at the time of transection of the proximal margin (7{\%}). Overall morbidity rates were 17{\%}. The anastomotic leak rate was 1.4{\%} (n = 2). There were no anastomotic leaks in the 11 patients who had a change in surgical plan based on intraoperative perfusion assessment with FA.Conclusions PINPOINT is a safe and feasible tool for intraoperative assessment of tissue perfusion during colorectal resection. There were no anastomotic leaks in patients in whom the anastomosis was revised based on inadequate perfusion with FA.",
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AU - Wexner, Steven D.

AU - Martz, Joseph E.

AU - McLemore, Elisabeth C.

AU - Margolin, David A.

AU - Sherwinter, Danny A.

AU - Lee, Sang W.

AU - Senagore, Anthony J.

AU - Phelan, Michael J.

AU - Stamos, Michael J.

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N2 - Background Our primary objective was to demonstrate the utility and feasibility of the intraoperative assessment of colon and rectal perfusion using fluorescence angiography (FA) during left-sided colectomy and anterior resection. Anastomotic leak (AL) after colorectal resection increases morbidity, mortality, and, in cancer cases, recurrence rates. Inadequate perfusion may contribute to AL. The PINPOINT Endoscopic Fluorescence Imaging System allows for intraoperative assessment of anastomotic perfusion.Study Design This is a prospective, multicenter, open-label, clinical trial that assessed the feasibility and utility of FA for intraoperative perfusion assessment during left-sided colectomy and anterior resection at 11 centers in the United States.Results A total of 147 patients were enrolled, of whom 139 were eligible for analysis. Diverticulitis (44%), rectal cancer (25%), and colon cancer (21%) were the most prevalent indications for surgery. The mean level of anastomosis was 10 ± 4 cm from the anal verge. Splenic-flexure mobilization was performed in 81% and high ligation of the inferior mesenteric artery in 61.9% of patients. There was a 99% success rate for FA, and FA changed surgical plans in 11 (8%) patients, with the majority of changes occurring at the time of transection of the proximal margin (7%). Overall morbidity rates were 17%. The anastomotic leak rate was 1.4% (n = 2). There were no anastomotic leaks in the 11 patients who had a change in surgical plan based on intraoperative perfusion assessment with FA.Conclusions PINPOINT is a safe and feasible tool for intraoperative assessment of tissue perfusion during colorectal resection. There were no anastomotic leaks in patients in whom the anastomosis was revised based on inadequate perfusion with FA.

AB - Background Our primary objective was to demonstrate the utility and feasibility of the intraoperative assessment of colon and rectal perfusion using fluorescence angiography (FA) during left-sided colectomy and anterior resection. Anastomotic leak (AL) after colorectal resection increases morbidity, mortality, and, in cancer cases, recurrence rates. Inadequate perfusion may contribute to AL. The PINPOINT Endoscopic Fluorescence Imaging System allows for intraoperative assessment of anastomotic perfusion.Study Design This is a prospective, multicenter, open-label, clinical trial that assessed the feasibility and utility of FA for intraoperative perfusion assessment during left-sided colectomy and anterior resection at 11 centers in the United States.Results A total of 147 patients were enrolled, of whom 139 were eligible for analysis. Diverticulitis (44%), rectal cancer (25%), and colon cancer (21%) were the most prevalent indications for surgery. The mean level of anastomosis was 10 ± 4 cm from the anal verge. Splenic-flexure mobilization was performed in 81% and high ligation of the inferior mesenteric artery in 61.9% of patients. There was a 99% success rate for FA, and FA changed surgical plans in 11 (8%) patients, with the majority of changes occurring at the time of transection of the proximal margin (7%). Overall morbidity rates were 17%. The anastomotic leak rate was 1.4% (n = 2). There were no anastomotic leaks in the 11 patients who had a change in surgical plan based on intraoperative perfusion assessment with FA.Conclusions PINPOINT is a safe and feasible tool for intraoperative assessment of tissue perfusion during colorectal resection. There were no anastomotic leaks in patients in whom the anastomosis was revised based on inadequate perfusion with FA.

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