Meta-Analysis on the Efficacy of Indocyanine Green Fluorescence Angiography for Reduction of Anastomotic Leakage After Rectal Cancer Surgery

Abstract

Background Indocyanine green (ICG) fluorescence angiography is a new technique that help surgeons to assess the blood perfusion of the anastomotic intestine. The aim of this study is to evaluate whether ICG fluorescence angiography can reduce the anastomotic leakage (AL) rate after colorectal anastomoses for rectal cancer (RC) patients. Methods Studies comparing AL rates between use and nonuse of ICG fluorescence angiography up to April 2020 were systematically searched from PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure. A pooled analysis was performed for the available data regarding the baseline features, AL rate, and other surgical outcomes. ReMan 5.3 software was used to perform the statistical analysis. Quality evaluation and publication bias were also conducted. Results Thirteen studies with a total of 2593 patients (1121 in the ICG group and 1472 in the control group) undergoing colorectal anastomoses after RC surgery were included. In the pooled analysis, the baseline data, operation time, and intraoperative blood loss in 2 groups were all comparable and without significant heterogeneity. However, the AL rate in the ICG group was significantly lower (OR .31; 95% CI .22-.44; P < .00001) than that in the control group. Additionally, ICG fluorescence angiography was associated with a decreased overall complication rate (OR .60; 95% CI .47-.76; P < .0001) in patients who undergo RC surgery. Conclusions The present study revealed that ICG fluorescence angiography reduced AL rate after colorectal anastomoses for RC patients. However, more high-quality randomized controlled trials are needed to confirm this benefit.