AB050. SOH24AB_158. Indocyanine green fluorescence angiography for colorectal resections, where do we stand?—A systematic review and meta-analysis

Background: Various studies report that indocyanine green fluorescence angiography (ICGFA) can reduce anastomotic leak (AL) rates in colorectal resections. Correct ICGFA interpretation either reassures regarding bowel perfusion sufficiency or prompts a change in surgical strategy regarding planned transection level. We evaluated AL outcomes with ICGFA overall and in these subgroups via meta-analysis.

Methods: Systematic review using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines of studies utilising ICGFA in bowel perfusion assessment versus surgeon expertise alone extracting reported AL data for pooled analysis.

Results: Forty-one studies (12,651 patients) were selected. AL incidence was 4.3% with ICGFA and 8.4% with surgeon assessment alone [odds ratio (OR) 0.45, P<0.01] with randomized controlled trials (RCTs) reporting still significant although less benefit (OR 0.61, P<0.01 versus no ICGFA, non-RCTs OR 0.41, P<0.01) with a number needed to treat of 22 (24 in RCTs). In 33 studies reporting AL rate without and with an ICGFA-prompted change in transection level, ICGFA changed surgical strategy in 7.9% of patients. Interestingly AL incidence was 3.3% when ICGFA did not change strategy versus 5.5% when it did (OR 2.07, P<0.01) versus 7.5% when no ICGFA was used (OR 0.41, P<0.01). AL rates in rectal cancer resections alone were 8.2% overall (OR 0.39, P<0.01; 9.2% in RCTs) and 4.2%, 8.1% and 10.9% for no change, change, and no ICGFA, respectively (OR 0.66, P=0.04 in RCTs versus no ICGFA).

Conclusions: ICGFA is associated with significantly lower AL rates overall and in rectal cancer resections when both confirming surgeon decisions and prompting changed transection level.

Keywords: Change in plan; colorectal surgery; fluorescence angiography; indocyanine green; meta-analysis