FLuorescent Angiography in REduction of Anastomotic Leak in Rectal Cancer Surgery

Anastomotic leakage is a significant complication following rectal cancer surgery. Inadequate blood supply to the bowel ends may contribute to poor anastomotic healing, resulting in postoperative complications and prolonged hospitalization. Conventional intraoperative assessment of bowel perfusion relies on visual examination of bowel color, bleeding from the cut edges, and pulsation of mesenteric vessels. However, these methods are subjective and may not reliably identify areas of inadequate perfusion. Indocyanine green fluorescence angiography (ICG-FA) enables real-time visualization of tissue perfusion using near-infrared imaging following intravenous administration of ICG. This technique may help surgeons identify poorly perfused bowel segments before construction of the anastomosis. Previous randomized controlled trials have reported conflicting findings regarding its effectiveness in preventing anastomotic leakage, and evidence from Indian surgical populations remains limited. The FLARE study is a prospective, randomized, open-label, parallel-group trial comparing ICG fluorescence-guided perfusion assessment with conventional visual assessment during minimally invasive rectal cancer surgery. In the ICG group, fluorescence imaging will be performed before construction of the anastomosis to assess perfusion at both the proximal large bowel end and the distal rectal stump. If inadequate perfusion is identified, the surgeon may modify the planned bowel transection line to select a better-perfused segment. In the control group, bowel perfusion will be assessed using conventional visual methods without ICG fluorescence imaging. Both groups will undergo standard rectal cancer surgery and postoperative care. The study will evaluate whether fluorescence-guided perfusion assessment provides additional clinical benefit compared with conventional visual assessment.