Indocyanine green fluorescence angiography could reduce the risk of anastomotic leakage in rectal cancer surgery: a systematic review and meta-analysis of randomized controlled trials
Alessio Lucarini
Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
Search for more papers by this authorAndrea Martina Guida
Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
Department of Surgical Science, University Tor Vergata, Rome, Italy
Search for more papers by this authorMarion Orville
Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
Search for more papers by this authorCorresponding Author
Yves Panis
Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
Correspondence
Yves Panis, Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, 48ter Boulevard Victor-Hugo, Neuilly/Seine, France.
Email: [email protected]
Search for more papers by this authorAlessio Lucarini
Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
Search for more papers by this authorAndrea Martina Guida
Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
Department of Surgical Science, University Tor Vergata, Rome, Italy
Search for more papers by this authorMarion Orville
Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
Search for more papers by this authorCorresponding Author
Yves Panis
Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
Correspondence
Yves Panis, Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, 48ter Boulevard Victor-Hugo, Neuilly/Seine, France.
Email: [email protected]
Search for more papers by this authorAbstract
Aim
Several papers have shown that use of indocyanine green (ICG) decreases incidence of anastomotic leakage (AL) during colonic surgery, but no clear evidence has been found for rectal cancer surgery. Therefore, with this systematic review and meta-analysis of randomized controlled trials (RCTs) we aimed to assess if ICG could also reduce risk of AL in rectal cancer surgery.
Method
PubMed, Scopus, CINAHL and Cochrane databases were searched for RCTs assessing the effect of intraoperative ICG on the incidence of AL of the colorectal anastomosis. Pooled relative risk (RR) and pooled risk difference (RD) were obtained using models with random effects. Risk of bias was evaluated with the Rob2 tool and the quality of evidence was assessed using the GRADE Pro tool.
Results
Four RCTs were included for analysis, with a total of 1510 patients (743 controls and 767 ICG patients). The rate of AL was 9% in the ICG group (69/767) and 13.9% (103/743) in the control group (p = 0.003, RR −0.5, 95% CI −0.827 to −0.172, heterogeneity test 0%, p = 0.460). The RD in terms of incidence of AL was significantly decreased by 4.51% (p = 0.031, 95% CI −0.086 to −0.004, heterogeneity test 28%, p = 0.182) when using ICG.
Conclusion
Our meta-analysis suggested that use of ICG during rectal cancer surgery could reduce the rate of AL.
CONFLICT OF INTEREST STATEMENT
The authors disclose no conflict of interest.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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