Aim:The purpose of the study is to evaluate the role of intraoperative fluorescence angiography using Indocyanine green (ICG) assessment for microperfusion assessment in preventing anastomotic leaks during rectal cancer surgery. The fluorescence assessment is done using a near IR camera system which detects ICG fluorescence using fluorescence detection systems.

Procedure:

Following an informed consent, patients with rectal cancer planned for an anterior resection (high or low) will be prospectively randomised in a 1:1 fashion at the time of consenting into a conventional surgery arm (No IFA used) and an IFA arm. 

Conventional surgery arm (no IFA) 

Laparoscopic or robot-assisted AR (high or low) will be performed as per the surgeon preference. Perfusion assessment will be performed with white light (WL) only. 

IFA arm 

For participants randomized to surgery with IFA, AR will be performed according to the surgeon’s usual technique, using either a laparoscopic or a robotic approach. 

Two IFA assessments will be performed, each involving an intravenous bolus of 0.1 mg/kg of ICG. The first assessment will be performed after rectal mobilization but before bowel transection. Under white light laparoscopy, the point of planned bowel transection will be first marked. Using either an intra- or extracorporeal IFA technique, the time to first fluorescence and any change in the planned bowel transection point following IFA will be recorded. The second assessment will be performed after construction of the anastomosis. One additional IFA assessment is permitted at the operating surgeon’s discretion.