AB143. SOH25_AB_361. Indocyanine green fluorescence angiography for colorectal resections: the level one evidence

Background: Many clinical studies have assessed for a possible effect of indocyanine green fluorescence angiography (ICGFA) use on anastomotic leak (AL) rates in colorectal resections with intraoperative qualitative ICGFA interpretation either reassuring the surgeon’s judgement of sufficient perfusion or prompting a change in transection site. We analysed the existing level one evidence regarding ICGFA use and its effect on AL rates.

Methods: A systematic review was carried out according to PRISMA guidelines for randomised controlled trials (RCTs) using ICGFA for bowel perfusion assessment vs. surgeon expertise alone. Data reporting AL rate were extracted for pooled analysis.

Results: Seven RCTs including 2,911 patients (1,459 ICGFA vs. 1,452 controls) were included. AL incidence in the ICGFA group was 7.5% compared to 11.6% in controls [odds ratio (OR) =0.62; P<0.01], increasing to 7.9% and 12.8% respectively when assessing left sided and rectal resections only (OR =0.58; P<0.01). In the four studies where AL rates were reported for cases where ICGFA interpretation resulted in a change of surgical plan (1,044 ICGFA vs. 1,042 controls), ICGFA prompted change in 6.4% of patients. AL rate was not significantly lower when ICGFA interpretation did not change the transection site vs. when it did (6.7% vs. 7.5%; OR =0.77; P=0.58), but was significantly lower when there was no change compared to those without ICGFA (6.7% vs. 10.1%; OR =0.64; P<0.01).

Conclusions: Level one evidence indicates that ICGFA use is associated with significantly lower AL rates overall and for left-sided resections. Correcting transection level by ICGFA is unproven to mitigate AL.

Keywords: Indocyanine green fluorescence angiography (ICGFA); colorectal surgery; anastomotic leak (AL); systematic review; meta-analysis