the fluorescent substance that reduces complications after colon cancer surgery
Innovation and research to improve the lives of patients after complex surgeries such as operations to treat cancer pathologies such as colon and rectal cancer. In this case, the use of the indocyanine green in this type of intervention because, according to specialists, it is a substance that reduces complications due to leaking sutures.
Specifically, and as detailed by the doctor Salvador Morales Conde, Head of the Department of General Surgery and Digestive Diseases of Quirónsalud Sagrado Corazón, thanks to the use of indocyanine green the colon cancer surgery team has reduced the leakage rate from 6-8% to 1-2% in the colon cancer. “What is an important impact on our results, but the most important thing is not the numbers, but rather that 6 out of 100 patients with colon cancer stop suffering as a result of having a severe complication in their surgery,” he says.
In addition, the specialist continues, “in rectal cancer, these leaks have also been significantly reduced, which has led to protocols to avoid performing temporary ileostomies (artificial anus) to patients’.
Indocyanine green, a substance that turns fluorescent when exposed to near infrared light, It was initially used in ophthalmology and the utility of its use in surgery has been discovered. This substance is injected into the bloodstream to see if the tissues are well vascularized before anastomosing (joining them) and can also be used to inject it around a malignant tumor to see the lymphatic drainage of the same and identify possible routes of spread.
Along the same lines, Dr. Morales explains that «the basis of a good anastomosis is that there is no tension and that both ends to be joined are well vascularized, both parameters are very subjective, but especially vascularization, since it was based exclusively on the color of the tissue (for which factors as simple as the light of the operating room influence) or if when cutting the presence of a glittering red blood was observed ». For this reason, he clarifies, indocyanine green «makes it possible to convert this subjective parameter into an objective one by determining if the tissue is really well vascularized and it will allow the viability of that anastomosis.
The Quirónsalud Sagrado Corazón surgery team uses indocyanine green in all surgeries where an anastomosis is performed, although, as they explain, they have observed that its application acquires greater value in cancer of the left colon, cancer of the rectum or esophagus. «The vascularization of the section to be joined depends on the marginal arches of the main arteries which may be affected by technical issues of surgery or by patient-dependent factors —Such as diabetes or smoking—, in which these arches can present blood flow difficulties, “he clarifies.
The problem, they clarify from Quirónsalud Sagrado Corazón, is that when this technology began a few years ago, its true benefits and advantages were not known, nor the correct way to use it. «Together with other centers at the international level, we have established the protocols and determined the correct doses and the times necessary to determine its use.», Says Dr. Morales.
Currently, the expert continues, “our data on the results obtained in the use of the technique are published and are highly reproducible so they don’t need great expertise to apply them. In my opinion, I think we have opened an important path in this field it will undoubtedly improve the results of surgery ».
From Quirónsalud Sagrado Corazón, they also draw attention to the fact that they have been working on this technique for more than six years, a fact that, as they highlight, has opened the possibility of exploring other applications such as lymphadenectomy in gastric or colon cancer . «The ultimate goal of doing dissections of tissues that are a potential pathway for tumor spread, which will allow us to make more individualized approaches to patients in the future and improve results, which will undoubtedly have an impact on the recovery of patients and on survival ”, emphasizes Dr. Morales.
The use of indocyanine green allows the surgeon to be calmer, since it makes it easier for him to see that he is anastomosing a better vascularized tissue, which will result in a better postoperative period for patients. Of course, they conclude from Quirónsalud Sagrado Corazón, «the great beneficiary is the patient, one less complication is a patient and one less family suffers».