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

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Abstract

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.

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Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This study was supported by the Fujian province teaching reform project (grant no. FBJG20190063) and the Fujian medical university Key teaching reform Project (grant no. Y19001).

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Author notes

  1. Jiajing Lin and Bingqiu Zheng contributed equally to this work.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Taijiang, Fuzhou, Fujian, 350004, People’s Republic of China

    Jiajing Lin, Bingqiu Zheng, Suyong Lin, Zhihua Chen & Shaoqin Chen

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  1. Jiajing Lin
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  2. Bingqiu Zheng
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  3. Suyong Lin
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Contributions

SQC designed the study, obtained funding, analyzed the data, and revised the manuscript. JJL drafted the manuscript and supervised the study. SQC was a supporter of the funding (grant no. FBJG20190063) and participated in the drafting and subsequent revision of the manuscript. SYL, ZHC, and BQZ collected and analyzed the data. All authors read and approved the final manuscript.

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Correspondence to Shaoqin Chen.

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Lin, J., Zheng, B., Lin, S. et al. The efficacy of intraoperative ICG fluorescence angiography on anastomotic leak after resection for colorectal cancer: a meta-analysis. Int J Colorectal Dis 36, 27–39 (2021). https://doi.org/10.1007/s00384-020-03729-1

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