{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T08:12:30Z","timestamp":1788423150669,"version":"build-2803163510"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The choice between sphincter-saving surgery and abdominoperineal resection (APR) for low rectal cancer balances oncological radicality against functional preservation. Indocyanine green fluorescence angiography (ICG-FA) provides objective intraoperative assessment of bowel perfusion at the colonic stump, where ischemia is a leading cause of anastomotic failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>In this prospective, single-center, descriptive cohort study (January 2021\u2013December 2025) of more than 400 patients operated for colorectal cancer, 70 had low rectal cancer (\u22646 cm from the anal verge) and 27 underwent sphincter-saving surgery \u2014 7 intersphincteric resections, 4 immediate low colorectal or coloanal anastomoses, and 16 two-staged Turnbull\u2013Cutait pull-through procedures. ICG-FA of the colonic stump was performed in 22 patients (81.5%), with proximal repositioning of the resection line whenever fluorescence was inadequate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>ICG-FA prompted modification of the resection line in 9 of 22 patients (40%), almost always proximally, but never altered the decision between sphincter preservation and APR. A radical (R0) resection was achieved in 19 of 21 patients with margin status recorded; two had an involved circumferential margin (R1), both in locally advanced node-positive tumors. Postoperative complications occurred in 15 of 27 patients (56%), mostly Clavien\u2013Dindo grade I\u2013II. There was no 30-day mortality; one late in-hospital death from an independent myocardial infarction occurred beyond 30 days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Sphincter-saving surgery for low rectal cancer is feasible but carries substantial morbidity. ICG-FA is a reproducible, low-risk adjunct that informs intraoperative decision-making; whether it reduces anastomotic complications requires confirmation in randomized studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1873934","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T04:23:56Z","timestamp":1783571036000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Sphincter-saving surgery versus abdominoperineal resection in low rectal cancer: the role of indocyanine green fluorescence angiography in surgical decision-making"],"prefix":"10.3389","volume":"16","author":[{"given":"Mihaela C.","family":"Misca","sequence":"first","affiliation":[{"name":"Dr. I. Cantacuzino Clinical Hospital and Carol Davila University of Medicine and Pharmacy","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorin V.","family":"Petrea","sequence":"additional","affiliation":[{"name":"Dr. I. Cantacuzino Clinical Hospital and Carol Davila University of Medicine and Pharmacy","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana D.","family":"Boanta","sequence":"additional","affiliation":[{"name":"Parhon Endocrinology Institute","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorin","family":"Aldoescu","sequence":"additional","affiliation":[{"name":"Dr. I. Cantacuzino Clinical Hospital and Carol Davila University of Medicine and Pharmacy","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduard","family":"Catrina","sequence":"additional","affiliation":[{"name":"Dr. I. 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