Indocyanine green fluorescence angiography prevents anastomotic leakage in rectal cancer surgery: a systematic review and meta-analysis

Background The role of intraoperative use of indocyanine green (ICG) fluorescence angiography (ICGFA) to prevent anastomotic leakage (AL) in rectal cancer surgery remains controversial. Methods The systematic review for studies evaluating ICGFA in patients undergoing rectal cancer surgery in PubMed, Embase, Web of Science, and the Cochrane Library was performed up to April 30, 2020. The primary outcome was the incidence of AL. The analysis was performed using RevMan v5.3 and Stata v12.0 software. Results Eighteen studies comprising 4038 patients were included. In the present meta-analysis, intraoperative use of ICGFA markedly reduced AL rate (OR = 0.33; 95% CI: 0.24–0.45; P < 0.0001; I 2 = 0%) in rectal cancer surgery, which was still significant in surgeries limited to symptomatic AL (OR = 0.44; 95% CI: 0.31–0.64; P < 0.0001; I 2 = 22%). This intervention was also associated with shorter postoperative stays (MD = − 1.27; 95% CI: − 2.42 to − 0.13; P = 0.04; I 2 = 60%). However, reoperation rate (OR = 0.61; 95% CI: 0.34–1.10; P = 0.10; I 2 = 6%), ileus rate (OR = 1.30; 95% CI: 0.60–2.82; P = 0.51; I 2 = 56%), and surgical site infection rate (OR = 1.40; 95% CI: 0.62–3.20; P = 0.42; I 2 = 0%) were not significantly different between the two groups. Conclusion The use of ICGFA was associated with a lower AL rate after rectal cancer resection. However, more multi-center RCTs with large sample size are required to further verify the value of ICGFA in rectal cancer surgery.