This systematic review and meta-analysis evaluates the efficacy of near-infrared indocyanine green (ICG) fluorescence imaging in reducing anastomotic leakage (AL) rates in colorectal surgery. AL represents a serious postoperative complication associated with increased morbidity and mortality, while conventional perfusion assessment methods remain unreliable; ICG fluorescence imaging offers real-time intraoperative perfusion evaluation. Following PRISMA guidelines, we conducted a comprehensive literature search (2000–2025) across PubMed, Cochrane Library, and Web of Science, including randomized controlled trials (RCTs) and non-randomized studies comparing ICG with conventional techniques. Data extraction, risk-of-bias assessment, and statistical analyses were performed, supplemented by subgroup and sensitivity analyses to evaluate heterogeneity. The analysis incorporated 42 studies involving 14,228 patients, demonstrating that ICG significantly reduced AL incidence (RR = 0.46; 95% CI: 0.40–0.54; p < 0.0001), with consistent benefits observed in both RCTs (RR = 0.66; 95% CI: 0.51–0.85) and non-RCTs (RR = 0.40; 95% CI: 0.33–0.48). Additionally, ICG was associated with reduced postoperative adverse events (RR = 0.82; 95% CI: 0.75–0.89) and reoperation rates (RR = 0.64; 95% CI: 0.52–0.79), findings further supported by sensitivity analyses confirming robustness. The results indicate that ICG fluorescence imaging significantly decreases AL and related complications in colorectal surgery, demonstrating both safety and feasibility; however, further large-scale RCTs are warranted to validate its clinical utility.
Qiu et al. (Wed,) studied this question.