Indocyanine green fluorescence angiography prevents anastomotic leakage in rectal cancer surgery: a systematic review and meta-analysis
- 7 January 2021
- journal article
- review article
- Published by Springer Science and Business Media LLC in Langenbecks Archiv für Chirurgie
- Vol. 406 (2), 261-271
- https://doi.org/10.1007/s00423-020-02077-6
Abstract
Background The role of intraoperative use of indocyanine green (ICG) fluorescence angiography (ICGFA) to prevent anastomotic leakage (AL) in rectal cancer surgery remains controversial. Methods The systematic review for studies evaluating ICGFA in patients undergoing rectal cancer surgery in PubMed, Embase, Web of Science, and the Cochrane Library was performed up to April 30, 2020. The primary outcome was the incidence of AL. The analysis was performed using RevMan v5.3 and Stata v12.0 software. Results Eighteen studies comprising 4038 patients were included. In the present meta-analysis, intraoperative use of ICGFA markedly reduced AL rate (OR = 0.33; 95% CI: 0.24–0.45; P < 0.0001; I2 = 0%) in rectal cancer surgery, which was still significant in surgeries limited to symptomatic AL (OR = 0.44; 95% CI: 0.31–0.64; P < 0.0001; I2 = 22%). This intervention was also associated with shorter postoperative stays (MD = − 1.27; 95% CI: − 2.42 to − 0.13; P = 0.04; I2 = 60%). However, reoperation rate (OR = 0.61; 95% CI: 0.34–1.10; P = 0.10; I2 = 6%), ileus rate (OR = 1.30; 95% CI: 0.60–2.82; P = 0.51; I2 = 56%), and surgical site infection rate (OR = 1.40; 95% CI: 0.62–3.20; P = 0.42; I2 = 0%) were not significantly different between the two groups. Conclusion The use of ICGFA was associated with a lower AL rate after rectal cancer resection. However, more multi-center RCTs with large sample size are required to further verify the value of ICGFA in rectal cancer surgery.Funding Information
- 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (ZY2017304)
- Sichuan Science and Technology Program (No.2019YFS0255)
- Ten Thousand Talent Program of Sichuan Province (No.101)
This publication has 53 references indexed in Scilit:
- Systematic review of methods to predict and detect anastomotic leakage in colorectal surgeryColorectal Disease, 2014
- The economic impact of anastomotic leakage after anterior resections in English NHS hospitals: are we adequately remunerating them?Colorectal Disease, 2013
- The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgerySurgical Endoscopy, 2013
- Risk Factors for Anastomotic Leakage After Anterior Resection for Rectal CancerJAMA Surgery, 2013
- A Review of Indocyanine Green Fluorescent Imaging in SurgeryInternational Journal of Biomedical Imaging, 2012
- Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakageLangenbecks Archiv für Chirurgie, 2010
- Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analysesEuropean Journal of Epidemiology, 2010
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaborationJournal of Clinical Epidemiology, 2009
- The Clavien-Dindo Classification of Surgical ComplicationsAnnals of Surgery, 2009
- Grading quality of evidence and strength of recommendationsBMJ, 2004