e16097 Background: Anastomotic leak remains one of the most serious complications following esophagectomy for esophageal cancer, contributing to prolonged hospitalization, morbidity, and mortality. Intraoperative indocyanine green (ICG) fluorescence angiography has been introduced to objectively assess conduit perfusion and potentially reduce leak rates; however, its clinical benefit remains uncertain. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of ICG fluorescence angiography during esophagectomy. Methods: A comprehensive systematic search of major electronic databases was conducted to identify comparative studies evaluating ICG fluorescence angiography versus standard assessment during esophagectomy for esophageal cancer. Pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using random-effects models. Results: Eleven studies encompassing 1,069 patients were included, with 524 patients in the ICG group and 545 in the control group. The mean age was 65.2 ± 8.22 years in the ICG group and 63.6 ± 9.26 years in the control group, with male predominance across studies. Use of ICG fluorescence angiography was associated with a lower risk of anastomotic leak compared with conventional assessment, although this reduction did not reach statistical significance (RR 0.58, 95% CI 0.25–1.34). No significant differences were observed in operative time (MD −0.14 minutes, 95% CI −0.30 to 0.01), hospital length of stay (MD −0.16 days, 95% CI −0.36 to 0.05), 90-day mortality (RR 1.06, 95% CI 0.26–4.35), or overall postoperative complications (RR 0.88, 95% CI 0.70–1.12). Conclusions: Intraoperative ICG fluorescence angiography appears to be a safe adjunct during esophagectomy and may offer a clinically meaningful reduction in anastomotic leak rates, although current evidence does not demonstrate statistically significant benefits in key postoperative outcomes. These findings suggest that ICG-guided perfusion assessment holds promise but should complement, rather than replace, surgical judgment. Well-designed randomized trials with standardized protocols are needed to clarify its true impact and define which patients are most likely to benefit.
Din et al. (Thu,) studied this question.