154 ABSTRACT Background. Anastomotic leakage (AL) is a dreaded complication following colorectal cancer surgery, impacting patient outcome, and leads to increasing healthcare consumption as well as economic burden. Bowel perfusion is a significant modifiable factor for anastomotic healing and thus crucial for reducing AL. Aims. The study aimed to calculate a cut-off value for quantified laser speckle perfusion units (LSPUs) in order to differentiate between ischemic and well-perfused tissue and to assess inter-observer reliability. Methods. LSCI was performed using a porcine ischemic small bowel loop model with the PerfusiX-Imaging® system. An ischemic area, well-perfused area, and two watershed areas were selected based on the LSCI colourmap. Subsequently, local capillary lactate (LCL) levels were measured. A logarithmic curve estimation tested the correlation between LSPU and LCL levels. A cut-off value for LSPU and lactate was calculated, based on anatomically ischemic and well-perfused tissue. Inter-observer variability analysis was performed with 10 observers. Results. Directly after ligation of the mesenteric arteries, differences in LSPU values between ischemic and well perfused tissue were significant (p<0.001) and increased significantly throughout all following measurements. LCL levels were significantly different (p<0.001) at both 60 and 120 minutes. Logarithmic curve estimation showed an R2-value of 0.56 between LSPU and LCL values. A LSPU cut-off value was determined at 69, with a sensitivity of 0.94 and specificity of 0.87. A LCL cut-off value of 3.8 mmol/L was found, with a sensitivity and specificity of 0.97 and 1.0 respectively. There was no difference in assessment between experienced and unexperienced observers. Cohen’s Kappa values were moderate to good (0.52-0.66). Conclusion. Real-time quantification of LSPUs may be a feasible intraoperative method to assess tissue perfusion and a cut-off value could be determined with high sensitivity and specificity. Inter-observer variability was moderate to good, irrespective of prior experience with the technique. Keywords: Anastomotic leakage; image-guided surgery; laparoscopic surgery; laser speckle contrast imaging; perfusion assessment.
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