Plenary Session
AB099. SOH26AB_0287. Indocyanine green fluorescence angiography for anastomotic perfusion assessment in colorectal surgery: systematic review with meta-analysis, meta-regression, and trial-sequential analyses
Odhrán Ryan1, Éanna Ryan1, Neil Corrigan2, Gemma Ainsworth3, Denise E. Hilling3,4, Alexander Vahrmeijer4, Jyrki Kössi5, Jun Watanabe6, David Jayne2, Ronan Cahill1,7
1Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland;
2Leeds Institute of Medical Research, University of Leeds, Leeds, UK;
3Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands;
4Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam, The Netherlands;
5Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland;
6Department of Colorectal Surgery, Kansai Medical University, Hirakata, Japan;
7Department of Surgery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
Background: Anastomotic leak (AL) is a serious complication in colorectal surgery. Indocyanine green fluorescence angiography (ICGFA) is an adjunctive digital method of assessing bowel perfusion intraoperatively. This systematic review and meta-analysis aimed to evaluate whether ICGFA use during surgery reduces postoperative AL using exclusively randomised controlled trial (RCT) data.
Methods: We conducted a comprehensive analysis of English-language RCTs comparing additive intraoperative ICGFA with standard surgeon perfusion assessment alone in patients undergoing colorectal resection with primary anastomosis according to prespecified criteria and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO registration: CRD420250652639), extracting summary-level data from included reports. The primary outcome was the overall AL rate. Sensitivity analyses, meta-regression, and trial sequential analysis (TSA) were performed.
Results: Nine RCTs, including 4,754 patients, were analysed. ICGFA significantly reduced overall AL [relative risk (RR) =0.66; 95% confidence interval (CI): 0.55–0.79; P<0.01; number needed to treat (NNT) =24] with TSA showing that the required information size (RIS =2,183) is exceeded overall. ICGFA reduced both AL requiring intervention (RR =0.704; 95% CI: 0.60–0.93; P<0.01; NNT =41) and AL not requiring intervention (RR =0.48; 95% CI: 0.31–0.72; P<0.01; NNT =35). Significant benefit was observed for left-sided (RR =0.62; 95% CI: 0.51–0.74; P<0.01; NNT =19), rectal (RR =0.62; 95% CI: 0.51–0.76; P<0.01; NNT =19) and low anterior (RR =0.62; 95% CI: 0.48–0.79; P<0.01; NNT =13) resections but not for right-sided resections. Among all tested covariates, only patient body mass index (BMI) significantly modified the ICGFA treatment effect, with an increasing protective effect with increasing BMI. Sensitivity analyses confirmed robustness of main findings with a strong level of recommendation enabled based on high certainty evidence for overall, left-sided, rectal, asymptomatic, and 30-day AL impact, and moderate certainty regarding clinically significant AL.
Conclusions: Intraoperative use of ICGFA reduces AL rates in left-sided and rectal colorectal resections. Given the evidence available now, further general efficacy trials are no longer required.
Keywords: Anastomotic leak (AL); colorectal surgery; indocyanine green fluorescence angiography (ICGFA); near-infrared laparoscopy; rectal cancer
Acknowledgments
None.
Funding: None.
Conflicts of Interest: The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
doi: 10.21037/map-26-ab099
Cite this abstract as: Ryan O, Ryan É, Corrigan N, Ainsworth G, Hilling DE, Vahrmeijer A, Kössi J, Watanabe J, Jayne D, Cahill R. AB099. SOH26AB_0287. Indocyanine green fluorescence angiography for anastomotic perfusion assessment in colorectal surgery: systematic review with meta-analysis, meta-regression, and trial-sequential analyses. Mesentery Peritoneum 2026;10:AB099.
