Comprehensive assessment of intestinal anastomosis viability in rectal cancer: fluorescence angiography, inflammatory biomarkers, and morphological verification

Introduction. Anastomotic leakage (AL) remains one of the most severe postoperative complications in the surgical treatment of rectal cancer. Ischemic microcirculatory disturbances in the anastomotic zone represent a leading factor in the development of this complication and may be exacerbated after neoadjuvant radiotherapy (NRT). Conventional methods for assessing bowel perfusion are largely subjective; therefore, objective intraoperative techniques, particularly indocyanine green (ICG) fluorescence angiography, are gaining increasing importance. In addition, monitoring early inflammatory markers-procalcitonin (PCT) and C-reactive protein (CRP)-in combination with morphological tissue assessment has significant prognostic value for the timely detection of AL. Aim. To evaluate the relationship between intraoperative intestinal wall perfusion, inflammatory biomarker levels, and morphological signs of ischemia in predicting anastomotic leakage after rectal resection. Materials and Methods. A prospective cohort study was conducted involving 107 patients with stage I-III rectal cancer who underwent anterior or low anterior resection with colorectal anastomosis. Patients were divided into two groups according to the method of perfusion assessment: the ICG(-) group, which underwent standard visual evaluation, and the ICG(+) group, in which indocyanine green fluorescence angiography was applied. Clinical, morphological, and laboratory parameters (CRP, PCT), as well as instrumental data from intraoperative angiography, were analyzed. Statistical analysis was performed using the Mann–Whitney U test, correlation analysis, and ROC analysis, with a significance level set at p