The efficacy of intraoperative ICG fluorescence angiography on anastomotic leak after resection for colorectal cancer: a meta-analysis

Objective The purpose of this study was to investigate whether intraoperative indocyanine green fluorescence angiography can reduce the incidence of anastomotic leak. Methods Present authors conducted a systematic search of PubMed, EMBASE, and Cochrane databases for randomized controlled trials (RCTs), prospective nonrandomized trials, and retrospective trials up to March 2020. Eleven papers fulfilling the screening criteria were included. Intervention Indocyanine green was injected intravenously after the division of the mesentery and colon but before anastomosis. The primary outcome measure was AL rate with at least 3 months of follow-up. Secondary outcome measure was operation time, postoperative complications, surgical site infection, reoperation, and ileus rate. The results were analyzed using STATA 12.0 software (Stata Corp, College Station, TX, USA). Result A total of 3137 patients were collected in 11 studies. Meta-analysis showed that compared with conventional surgery, the ICG fluorescence angiography resulted in a fewer AL rate (OR = 0.31; 95% CI 0.21 to 0.44;P< 0.0001), postoperative complications (OR = 0.70; 95% CI 0.51 to 0.96;P< 0.025), and reoperation rate (OR = 0.334; 95% CI 0.16 to 0.68;P= 0.003). Operation time (weighted mean difference - 25.162 min; 95% CI - 58.7 to 8.375;P= 0.141), surgical site infection rate (OR = 1.11; 95% CI 0.59 to 2.09;P= 0.742) did not differ between the two groups. Conclusion The result revealed that indocyanine green was associated with a lower anastomotic leakage rate after colorectal cancer resection. However, larger, multicentered, high-quality randomized controlled trials are needed to confirm the benefit of indocyanine green fluorescence angiography.

Automated summary

The study found that intraoperative indocyanine green fluorescence angiography can reduce the rate of anastomotic leak, postoperative complications, and reoperation after colorectal cancer resection. However, there was no significant difference in operation time and surgical site infection rate between the two groups.