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Background: Various studies report that indocyanine green fluorescence angiography (ICGFA) can reduce anastomotic leak (AL) rates in colorectal resections. Correct ICGFA interpretation either reassures regarding bowel perfusion sufficiency or prompts a change in surgical strategy regarding planned transection level. We evaluated AL outcomes with ICGFA overall and in these subgroups via meta-analysis. Methods: Systematic review using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines of studies utilising ICGFA in bowel perfusion assessment versus surgeon expertise alone extracting reported AL data for pooled analysis. Results: Forty-one studies (12,651 patients) were selected. AL incidence was 4.3% with ICGFA and 8.4% with surgeon assessment alone odds ratio (OR) 0.45, P<0.01 with randomized controlled trials (RCTs) reporting still significant although less benefit (OR 0.61, P<0.01 versus no ICGFA, non-RCTs OR 0.41, P<0.01) with a number needed to treat of 22 (24 in RCTs). In 33 studies reporting AL rate without and with an ICGFA-prompted change in transection level, ICGFA changed surgical strategy in 7.9% of patients. Interestingly AL incidence was 3.3% when ICGFA did not change strategy versus 5.5% when it did (OR 2.07, P<0.01) versus 7.5% when no ICGFA was used (OR 0.41, P<0.01). AL rates in rectal cancer resections alone were 8.2% overall (OR 0.39, P<0.01; 9.2% in RCTs) and 4.2%, 8.1% and 10.9% for no change, change, and no ICGFA, respectively (OR 0.66, P=0.04 in RCTs versus no ICGFA). Conclusions: ICGFA is associated with significantly lower AL rates overall and in rectal cancer resections when both confirming surgeon decisions and prompting changed transection level.
Singaravelu et al. (Wed,) studied this question.