Abstract
ABSTRACT Introduction Systematic reviews of retrospective studies suggest that indocyanine green (ICG) angiography reduces anastomotic leak (AL) and improves postoperative outcomes. This systematic review and meta-analysis evaluates colorectal surgery outcomes following ICG use with comparison of results found in randomized controlled trials (RCTs) and retrospective studies. Methods A systematic search was conducted of studies evaluating ICG in colorectal surgery with more than five patients. Systematic search of MEDLINE, Embase, Scopus, and Web of Science was conducted in August 2021 and this study followed PRISMA and MOOSE guidelines. Primary outcome was AL. Meta-analysis was conducted with RevMan 5.4. Results Overall, 2403 studies were retrieved with 28 total studies including three RCTs meeting criteria. RCTs included 964 patients, whereas other studies comprised 7327 patients with 44.6% receiving ICG. The ICG and non-ICG cohorts were similar with respect to age (62.6 vs 63.1 years), sex (45.1% vs 43.1% female), smoking (22.4% vs 25.3% smokers), and diabetes (13.4% vs 14.2%), respectively. Anastomotic height (6.5 vs 6.8 cm) and technique (78.7% vs 74.8% stapled) were also comparable. With retrospective studies included, ICG was associated with AL reduction (odds ratio [OR] 0.41; 95% CI, 0.32–0.53; p < 0.001) and reoperation for AL (OR 0.64; 95% CI, 0.43–0.95; p = 0.03), with pronounced effects for rectal anastomoses (OR 0.31; 95% CI, 0.21–0.44; p < 0.001). RCT evidence suggests a much smaller effect size (OR 0.64; 95% CI, 0.42–0.99; p = 0.04), and no reduction in AL reoperation (OR 0.72; 95% CI, 0.29–1.80; p = 0.48) or length of stay (LOS). Conclusion Retrospective studies suggest reduced AL, reoperation for AL, and LOS with ICG angiography. However, RCTs suggest a smaller effect size and do not demonstrate reduced reoperation or LOS. Additional RCTs are required before widespread ICG uptake.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Innovations in Surgery and Interventional Medicine
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
