Intraoperative perfusion assessment of the proximal colon by a visual grading system for safe anastomosis after resection in left-sided colorectal cancer patients

Abstract

We aimed to evaluate the clinical feasibility of a new visual grading system. We included 50 patients who underwent resection of primary colorectal cancer. Before anastomosis, the marginal vessel was cut and the perfusion status was assessed by a visual grading system. The visual grading system is comprised of five grades according to the bleeding from the marginal vessel and is categorized into 4 groups: good (grade A and B), moderate (grade C), poor (grade D) and none (grade E). Colorectal anastomosis was performed only in the good and moderate groups. We compared postoperative outcomes between the good and moderate groups and analysed the factors affecting the perfusion grade. Among the patients, 48% were grade A, 12% were grade B, and 40% were grade C. There was no anastomotic leakage. Only one patient with grade C showed ischemic colitis and needed reoperation. Age was the only factor correlated with perfusion grade in multivariate analysis (OR 1.080, 95% CI 1.006–1.159, p = 0.034). The perfusion grades were significantly different between > 65 and < 65 year-old patients (> 65, A 29.2% B 12.5% C 58.3% vs. < 65, A 65.4% B 11.5% C 23.1%, p = 0.006). Our intraoperative perfusion assessment that uses a cutting method and a visual grading system is simple and useful for performing a safe anastomosis after colorectal resection. If the perfusion grade is better than grade C, an anastomosis can be performed safely. Age was found to be an important factor affecting the perfusion grade.

The effect of pain-education nursing based on a mind map on postoperative pain score and quality of life in patients with colorectal cancer

“…[ 14 ] It is an important tool for hospitals to transform from purely therapeutic services into holistic care centers focused on prevention, treatment, nursing, and rehabilitation integrated with health care, which has the advantage of low costs and high output. [ 15 ] It has become an industry consensus to vigorously conduct pain-education nursing based on mind mapping to promote hospital modernization. [ 16 ] However, only a few clinical studies have been conducted on pain-education nursing based on mind mapping in China.…”

Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery

“…Ryu et al [29] attempted to determine the perfusion status by grading the bleeding of marginal vessels during left colon cancer surgery. They proposed a visual grading system that categorizes the bleeding from the marginal vessel into four groups.…”

Mesenteric Vascular Evaluation with Pre-operative Multidetector Computed Tomographic Angiography and Intraoperative Indocyanine Green Angiography to Reduce Anastomotic Leaks after Minimally Invasive Surgery for Colorectal Cancer

“…Cutting of the marginal vessel and perfusion status assessment by a visual grading system, visible light spectroscopy for serosal oxygen saturation, and multispectral imaging for tissue oxygen saturation are other methods that have been used throughout the years. [13][14][15] At our institution over the past two years, anastomotic leak rates following minimally invasive colorectal surgery for cancer have been 6.8%. The purpose of this study was to determine the effect of introducing routine use of preoperative vascular anatomy evaluation using MDCTA and intraoperative vascular evaluation using ICG angiography on the anastomotic leak rate of colorectal cancer patients undergoing minimally invasive resection.…”