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Effect of indocyanine green fluorescence angiography on preventing anastomotic leakage after colorectal surgery: a meta-analysis

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Abstract

Anastomotic leakage (AL) is a serious but not uncommon complication after colorectal surgery. We conducted this study to evaluate the effect of routine indocyanine green fluorescence angiography (ICG-FA) on reducing the AL rate after colorectal surgery. We identified all research articles about colorectal surgery using ICG-FA, published in the PubMed, EMBASE, and Cochrane Library databases from the date of database establishment to May 2020. Revman 5.3 was used for statistical analysis. We analyzed 22 controlled studies and 7 non-controlled studies on ICG-FA, including 6312 patients. The controlled studies included 2354 patients in the ICG group and 3522 patients in the non-ICG group. Meta-analysis showed that ICG-FA reduced the AL rate after colorectal surgery significantly (RR = 0.39; 95% CI 0.30–0.50; P < 0.00001). However, patients whose resection line was changed based on the fluorescence angiography had a higher AL rate than those whose resection line was not changed (OR = 5.37; 95% CI 2.67–10.81; P < 0.00001). The overall complication rate, severe complication rate, and reoperation rate in the ICG group were significantly lower than those in the non-ICG group (RR = 0.79, 95% CI 0.67–0.92, P = 0.002; RR = 0.67, 95% CI 0.47–0.96, P = 0.03; RR = 0.53, 95% CI 0.29–0.96, P = 0.04, respectively), whereas the postoperative ileus rate was significantly higher in the ICG group than in the non-ICG group (RR = 1.65; 95% CI 1.09–2.50; P = 0.02), especially in Western countries (RR = 1.6; 95% CI 1.04–2.47; P = 0.03).

ICG-FA may reduce the AL rate after colorectal surgery, but ICG-FA group patients with transection line change for insufficient blood perfusion to the anastomotic stoma after evaluation had a higher AL rate than those without transection line change. Therefore, ICG-FA can help to identify patients at high risk of AL and intercept its occurrence. Moreover, ICG-FA may reduce the overall complication rate, severe complication rate, and reoperation rate, but induce postoperative ileus. High-quality randomized-controlled trials with a placebo control are needed to further evaluate the effectiveness and safety of ICG-FA.

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Abbreviations

ICG:

Indocyanine green

FA:

Fluorescence angiography

NIR:

Near-infrared

AL:

Anastomotic leakage

RCTs:

Randomized-controlled trials

RCSs:

Retrospective cohort studies

PCSs:

Prospective cohort studies

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Acknowledgements

We thank all the reviewers and editors for their helpful suggestions to improve the quality of our paper. Everyone who contributed to the article met the criteria for authorship, including those who provided professional writing services or materials.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. We have no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China

    Wei Zhang & Xu Che

  2. Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China

    Xu Che

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  1. Wei Zhang
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WZ was responsible for drafting the manuscript, as well as the acquisition, analysis, and interpretation of data. XC contributed to the concept and design of the study. Both authors read and approved the final manuscript.

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Correspondence to Xu Che.

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Drs. Zhang Wei and Che Xu have no conflicts of interest or financial ties to disclose.

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Ethical approval was not necessary, as this study was a “Systematic Review and Meta-analysis.” There are no individual person's data or details of case reports disclosed in this article.

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Zhang, W., Che, X. Effect of indocyanine green fluorescence angiography on preventing anastomotic leakage after colorectal surgery: a meta-analysis. Surg Today 51, 1415–1428 (2021). https://doi.org/10.1007/s00595-020-02195-0

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