Laser speckle contrast imaging for real-time assessment of colonic perfusion to prevent anastomotic leakage after anterior rectal resection: A single-centre prospective pilot study.

Abstract

Anastomotic leakage (AL) is a devastating complication following anterior rectal resection. This study aimed to evaluate whether a strategy utilizing real-time Laser Speckle Contrast Imaging (LSCI) for intraoperative perfusion assessment could reduce the incidence of AL. We conducted a single-centre study comparing a prospective cohort undergoing LSCI-guided surgery (LSCI group) with a historical cohort (retrospective group). Propensity score matching (PSM) was used to balance baseline characteristics. The LSCI system was used to objectively assess bowel perfusion and guide the selection of the proximal transection site. The primary outcome was the rate of anastomotic leakage. After PSM, 105 patients in the LSCI group were matched with 176 patients in the control group, with all baseline characteristics being comparable. The incidence of AL was significantly lower in the LSCI group compared to the control group (1.9% vs. 8.5%, p < 0.05). Furthermore, the rate of severe postoperative infective complications requiring major intervention (percutaneous drainage or reoperation) was also significantly reduced in the LSCI group (1.9% vs. 9.6%; p = 0.02). In the LSCI group, real-time perfusion assessment led to an intraoperative change of the planned anastomotic site in 6 patients (5.7%), predominantly in low-to-middle rectal cancer cases. The use of an LSCI-guided strategy for real-time intraoperative perfusion assessment may reduce the rates of both AL and severe postoperative infective complications undergoing ARR surgery. This objective, quantitative technology is a valuable tool for optimizing surgical decision-making and improving patient outcomes.