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Does intraoperative indocyanine green fluorescence angiography decrease the incidence of anastomotic leakage in colorectal surgery? A systematic review and meta-analysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Colorectal anastomoses in patients with colorectal cancer carry a high risk of leakage. Indocyanine green fluorescence angiography (ICG-FA) is a new technique that allows surgeons to assess the blood perfusion of the anastomosis during operation. This meta-analysis aimed to evaluate whether ICG-FA could prevent anastomotic leakage (AL) in colorectal surgery.

Methods

Four databases (PubMed, Embase, Web of Science, and Cochrane Library) were searched to identify suitable literatures until March 2020 that compared AL rates between intraoperative use and non-use of ICG-FA in colorectal surgery for cancer. The Review Manager 5.3 software was used to perform the statistical analysis. Evaluation of articles quality and analysis for publication bias were also conducted.

Results

Thirteen studies of 4037 patients were included in the meta-analysis. The study included 1806 patients in the ICG group and 2231 patients in the control group. The pooled incidence of AL in ICG group was 3.8% compared with 7.8% in control group. There was a significant difference in AL rate with or without use of ICG-FA (OR 0.44; 95% CI 0.33–0.59; P < 0.00001). Reoperation rates were 2.6% and 6.9% in ICG and control groups, respectively. Application of intraoperative ICG-FA was associated with a lower risk of reoperation (OR 0.39; 95% CI 0.16–0.94; P = 0.04). Overall complication rate was 15.6% in the ICG group compared with 21.2% in the control group. Overall complications were significantly reduced when using ICG-FA (OR 0.62; 95% CI 0.47–0.82; P = 0.0008). Mortality rate was not statistically different with or without the use of ICG-FA (OR 1.22; 95% CI 0.20–7.30; P = 0.83).

Conclusion

The results revealed that ICG-FA reduced risks of AL, reoperation, and overall complications for colorectal cancer patients undergoing colorectal surgery. Well-designed RCTs are needed to confirm the usefulness of intraoperative ICG-FA for preventing surgical complications like AL and reoperation.

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References

  1. Ellebaek MB, Rahr HB, Boye S, Fristrup C, Qvist N (2019) Detection of early anastomotic leakage by intraperitoneal microdialysis after low anterior resection for rectal cancer: a prospective cohort study. Color Dis 21(12):1387–1396

    CAS  Google Scholar 

  2. Park JS, Choi GS, Kim SH, Kim HR, Kim NK, Lee KY, Kang SB, Kim JY, Lee KY, Kim BC, Bae BN, Son GM, Lee SI, Kang H (2013) Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg 257(4):665–671

    PubMed  Google Scholar 

  3. Kingham TP, Pachter HL (2009) Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am Coll Surg 208(2):269–278

    Google Scholar 

  4. Sverrisson I, Folkvaljon F, Chabok A, Stattin P, Smedh K, Nikberg M (2019) Anastomotic leakage after anterior resection in patients with rectal cancer previously irradiated for prostate cancer. Eur J Surg Oncol 45(3):341–346

    PubMed  Google Scholar 

  5. Ptok H, Marusch F, Meyer F, Schubert D, Gastinger I, Lippert H, Study Group Colon/Rectum Carcinoma (Primary Tumour) (2007) Impact of anastomotic leakage on oncological outcome after rectal cancer resection. Br J Surg 94(12):1548–1554

    CAS  Google Scholar 

  6. Merkel S, Wang WY, Schmidt O et al (2001) Locoregional recurrence in patients with anastomotic leakage after anterior resection for rectal carcinoma. Color Dis 3(3):154–160

    CAS  Google Scholar 

  7. Ha GW, Kim JH, Lee MR (2017) Oncologic impact of anastomotic leakage following colorectal cancer surgery: a systematic review and meta-analysis. Ann Surg Oncol 24(11):3289–3299

    PubMed  Google Scholar 

  8. Peeters KC, Tollenaar RA, Marijnen CA et al (2005) Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 92(2):211–216

    CAS  PubMed  Google Scholar 

  9. Matthiessen P, Hallbook O, Andersson M, Rutegard J, Sjodahl R (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Color Dis 6(6):462–469

    CAS  Google Scholar 

  10. Yamamoto S, Fujita S, Akasu T, Inada R, Moriya Y, Yamamoto S (2012) Risk factors for anastomotic leakage after laparoscopic surgery for rectal cancer using a stapling technique. Surg Laparosc Endosc Percutan Tech 22(3):239–243

    PubMed  Google Scholar 

  11. Senagore AJ, Delaney CP, Madboulay K, Brady KM, Fazio VW (2003) Laparoscopic colectomy in obese and nonobese patients. J Gastrointest Surg 7(4):558–561

    PubMed  Google Scholar 

  12. Brandl A, Czipin S, Mittermair R, Weiss S, Pratschke J, Kafka-Ritsch R (2016) Transanal drainage tube reduces rate and severity of anastomotic leakage in patients with colorectal anastomosis: a case controlled study. Ann Med Surg 6:12–16

    CAS  Google Scholar 

  13. Qu H, Liu Y, Bi DS (2015) Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis. Surg Endosc 29(12):3608–3617

    Google Scholar 

  14. Rodriguez-Ramirez SE, Uribe A, Ruiz-Garcia EB, Labastida S, Luna-Perez P (2006) Risk factors for anastomotic leakage after preoperative chemoradiation therapy and low anterior resection with total mesorectal excision for locally advanced rectal cancer. Rev Investig Clin 58(3):204–210

    Google Scholar 

  15. Thompson SK, Chang EY, Jobe BA (2006) Clinical review: healing in gastrointestinal anastomoses, part I. Microsurgery 26(3):131–136

    PubMed  Google Scholar 

  16. Kusano M, Tajima Y, Yamazaki K, Kato M, Watanabe M, Miwa M (2008) Sentinel node mapping guided by indocyanine green fluorescence imaging: a new method for sentinel node navigation surgery in gastrointestinal cancer. Dig Surg 25(2):103–108

    PubMed  Google Scholar 

  17. Lin J, Lin LS, Chen DR, Lin KJ, Wang YF, Chang YJ (2020) Indocyanine green fluorescence method for sentinel lymph node biopsy in breast cancer. Asian J Surg

  18. Lu J, Huang CM (2019) Exploration and development of indocyanine green fluorescence applied in laparoscopic splenic hilum lymph node dissection for gastric cancer. Zhonghua Zhong Liu Za Zhi 41(12):900–903

    CAS  PubMed  Google Scholar 

  19. Degett TH, Andersen HS, Gogenur I (2016) Indocyanine green fluorescence angiography for intraoperative assessment of gastrointestinal anastomotic perfusion: a systematic review of clinical trials. Langenbeck's Arch Surg 401(6):767–775

    Google Scholar 

  20. Shen R, Zhang Y, Wang T (2018) Indocyanine green fluorescence angiography and the incidence of anastomotic leak after colorectal resection for colorectal cancer: a meta-analysis. Dis Colon Rectum 61(10):1228–1234

    PubMed  Google Scholar 

  21. Hu MH, Huang RK, Zhao RS, Yang KL, Wang H (2017) Does neoadjuvant therapy increase the incidence of anastomotic leakage after anterior resection for mid and low rectal cancer? A systematic review and meta-analysis. Color Dis 19(1):16–26

    Google Scholar 

  22. Shen Y, Yang T, Yang J, Meng W, Wang Z (2020) Intraoperative indocyanine green fluorescence angiography to prevent anastomotic leak after low anterior resection for rectal cancer: a meta-analysis. ANZ J Surg

  23. Dinallo AM, Kolarsick P, Boyan WP, Protyniak B, James A, Dressner RM, Arvanitis ML (2019) Does routine use of indocyanine green fluorescence angiography prevent anastomotic leaks? A retrospective cohort analysis. Am J Surg 218(1):136–139

    PubMed  Google Scholar 

  24. Hasegawa H, Tsukada Y, Wakabayashi M, Nomura S, Sasaki T, Nishizawa Y, Ikeda K, Akimoto T, Ito M (2020) Impact of intraoperative indocyanine green fluorescence angiography on anastomotic leakage after laparoscopic sphincter-sparing surgery for malignant rectal tumors. Int J Color Dis 35(3):471–480

    Google Scholar 

  25. Ishii M, Hamabe A, Okita K, Nishidate T, Okuya K, Usui A, Akizuki E, Satoyoshi T, Takemasa I (2020) Efficacy of indocyanine green fluorescence angiography in preventing anastomotic leakage after laparoscopic colorectal cancer surgery. Int J Color Dis 35(2):269–275

    Google Scholar 

  26. Skrovina M, Bencurik V, Martinek L et al (2020) The significance of intraoperative fluorescence angiography in miniinvasive low rectal resections. Wideochir Inne Tech Maloinwazyjne 15(1):43–48

    PubMed  Google Scholar 

  27. Wada T, Kawada K, Hoshino N, Inamoto S, Yoshitomi M, Hida K, Sakai Y (2019) The effects of intraoperative ICG fluorescence angiography in laparoscopic low anterior resection: a propensity score-matched study. Int J Clin Oncol 24(4):394–402

    PubMed  Google Scholar 

  28. Watanabe J, Ishibe A, Suwa Y, Suwa H, Ota M, Kunisaki C, Endo I (2020) Indocyanine green fluorescence imaging to reduce the risk of anastomotic leakage in laparoscopic low anterior resection for rectal cancer: a propensity score-matched cohort study. Surg Endosc 34(1):202–208

    PubMed  Google Scholar 

  29. Boni L, Fingerhut A, Marzorati A, Rausei S, Dionigi G, Cassinotti E (2017) Indocyanine green fluorescence angiography during laparoscopic low anterior resection: results of a case-matched study. Surg Endosc 31(4):1836–1840

    PubMed  Google Scholar 

  30. Jafari MD, Lee KH, Halabi WJ, Mills SD, Carmichael JC, Stamos MJ, Pigazzi A (2013) The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery. Surg Endosc 27(8):3003–3008

    PubMed  Google Scholar 

  31. Kim JC, Lee JL, Yoon YS, Alotaibi AM, Kim J (2016) Utility of indocyanine-green fluorescent imaging during robot-assisted sphincter-saving surgery on rectal cancer patients. Int J Med Robot Comput Assist Surg 12(4):710–717

    Google Scholar 

  32. Alekseev M, Rybakov E, Shelygin Y, Chernyshov S, Zarodnyuk I (2020) A study investigating the perfusion of colorectal anastomoses using FLuorescence AnGiography: results of FLAG randomized trial. Color Dis

  33. Kin C, Vo H, Welton L, Welton M (2015) Equivocal effect of intraoperative fluorescence angiography on colorectal anastomotic leaks. Dis Colon Rectum 58(6):582–587

    PubMed  Google Scholar 

  34. Kudszus S, Roesel C, Schachtrupp A, Hoer JJ (2010) Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage. Langenbeck's Arch Surg 395(8):1025–1030

    Google Scholar 

  35. Mizrahi I, Abu-Gazala M, Rickles AS, Fernandez LM, Petrucci A, Wolf J, Sands DR, Wexner SD (2018) Indocyanine green fluorescence angiography during low anterior resection for low rectal cancer: results of a comparative cohort study. Tech Coloproctol 22(7):535–540

    CAS  PubMed  Google Scholar 

  36. Leevy CM, Mendenhall CL, Lesko W, Howard MM (1962) Estimation of hepatic blood flow with indocyanine green. J Clin Invest 41:1169–1179

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Son GM, Kwon MS, Kim Y, Kim J, Kim SH, Lee JW (2019) Quantitative analysis of colon perfusion pattern using indocyanine green (ICG) angiography in laparoscopic colorectal surgery. Surg Endosc 33(5):1640–1649

    PubMed  Google Scholar 

  38. Wada T, Kawada K, Takahashi R, Yoshitomi M, Hida K, Hasegawa S, Sakai Y (2017) ICG fluorescence imaging for quantitative evaluation of colonic perfusion in laparoscopic colorectal surgery. Surg Endosc 31(10):4184–4193

    PubMed  Google Scholar 

  39. Boyle NH, Manifold D, Jordan MH, Mason RC (2000) Intraoperative assessment of colonic perfusion using scanning laser Doppler flowmetry during colonic resection. J Am Coll Surg 191(5):504–510

    CAS  PubMed  Google Scholar 

  40. Nickele C, Nguyen V, Fisher W, Couldwell W, Aboud E, David C, Morcos J, Charalampaki C, Arthur A (2019) A pilot comparison of multispectral fluorescence to indocyanine green videoangiography and other modalities for intraoperative assessment in vascular neurosurgery. Oper Neurosurg 17(1):103–109

    Google Scholar 

  41. Sherwinter DA, Gallagher J, Donkar T (2013) Intra-operative transanal near infrared imaging of colorectal anastomotic perfusion: a feasibility study. Color Dis 15(1):91–96

    CAS  Google Scholar 

  42. Chang YK, Foo CC, Yip J, Wei R, Ng KK, Lo O, Choi HK, Law WL (2019) The impact of indocyanine-green fluorescence angiogram on colorectal resection. Surgeon 17(5):270–276

    PubMed  Google Scholar 

  43. Rausa E, Zappa MA, Kelly ME, Turati L, Russo A, Aiolfi A, Bonitta G, Sgroi LG (2019) A standardized use of intraoperative anastomotic testing in colorectal surgery in the new millennium: is technology taking over? A systematic review and network meta-analysis. Tech Coloproctol 23(7):625–631

    CAS  PubMed  Google Scholar 

  44. Blanco-Colino R, Espin-Basany E (2018) Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Tech Coloproctol 22(1):15–23

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery, Anhui Provincial Hospital Affiliated to the Anhui Medical University, Hefei, China

    Dongliang Liu, Lichuan Liang & Zhiqiang Zhu

  2. Department of General Surgery, The First Hospital Affiliated to the University of Science and Technology of China, Lujiang Road 17, Lu Yang District, Hefei, Anhui Province, China

    Liu Liu & Zhiqiang Zhu

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  1. Dongliang Liu
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Contributions

DLL and ZQZ were involved in the study conception and design. DLL and LCL performed the data acquisition. DLL and LCL performed the analysis and interpretation of the data. DLL and LL drafted the manuscript. LCL and LL critically revised the manuscript. DLL and LL submitted the manuscript.

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Correspondence to Liu Liu or Zhiqiang Zhu.

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Liu, D., Liang, L., Liu, L. et al. Does intraoperative indocyanine green fluorescence angiography decrease the incidence of anastomotic leakage in colorectal surgery? A systematic review and meta-analysis. Int J Colorectal Dis 36, 57–66 (2021). https://doi.org/10.1007/s00384-020-03741-5

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