Deng Jia, Hu Wenting, Li Yang, Xiong Kai, Yue Tinghui, Lai Xiangquan, Xiao Tianbao
College of Clinical Medicine, Guizhou University of Traditional Chinese Medicine, Guiyang, China.
College of Pharmacy, Dali University, Dali, China.
Front Oncol. 2022 Oct 26;12:1010122. doi: 10.3389/fonc.2022.1010122. eCollection 2022.
This meta-analysis intended to systematically evaluate the clinical implications of indocyanine green fluorescence (ICG) in patients undergoing laparoscopic colorectal surgery. PubMed, MEDLINE, Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Medical Information System and China Biomedical Database were synthetically searched for studies published from inception to April 14, 2022. The randomized controlled trials comparing ICG-use with controls were selected. The incidence of anastomotic leakage (AL), lymph node detection, operation duration, intraoperative bleeding, postoperative morbidity, and hospitalization time were evaluated in summary analysis, and calculated the corresponding 95% confidence intervals (CI). Subsequently, in addition to subgroup analyses, studies for heterogeneity, sensitivity, and publication bias were carried out. Consequently, 3453 patients in the enrolled 15 studies were included; 1616 patients were allocated to the experimental group, and 1837 patients were assigned to the control group. The ICG group had a significantly decreased risk of AL (RR: 0.50, 95% CI: 0.37-0.67) and shorter hospitalization time (SMD: -0.31, 95% CI: -0.54-0.08) compared to the control group. Meanwhile, the ICG showed clearly better lymph node detection (SMD: 0.19, 95% CI: 0.02-0.36). However, when the content of operation duration (SMD: -0.07, 95% CI: -0.30-0.15) and intraoperative bleeding (SMD: -0.16, 95% CI: -0.35-0.04) were compared, no statistical significance was found. Furthermore, the pooled analysis of postoperative morbidity was not statistically significant (RR:0.79, 95% CI: 0.58-1.08). The results of the subgroup analysis of AL indicated that there may be regional variations in AL (RR: 0.50, 95% CI: 0.37-0.67) but not in postoperative morbidity (RR: 0.79, 95% CI: 0.58-1.08). In conclusion, the application of ICG in laparoscopic colorectal surgery can effectively reduce the AL, lymph node detection, and hospitalization time. However, more multicenter large-sample randomized controlled trials are required to further confirm its advantages. The meta-analysis was registered in PROSPERO (no. CRD42022288054).
本荟萃分析旨在系统评价吲哚菁绿荧光（ICG）在接受腹腔镜结直肠手术患者中的临床意义。综合检索了PubMed、MEDLINE、Cochrane图书馆、EMBASE、中国知网（CNKI）、万方数据库、维普医药信息系统和中国生物医学数据库，查找从建库至2022年4月14日发表的研究。选取了比较使用ICG与对照组的随机对照试验。在汇总分析中评估吻合口漏（AL）的发生率、淋巴结检出情况、手术时长、术中出血、术后发病率和住院时间，并计算相应的95%置信区间（CI）。随后，除进行亚组分析外，还开展了异质性、敏感性和发表偏倚研究。结果，纳入的15项研究中的3453例患者被纳入分析；1616例患者被分配至试验组，1837例患者被分配至对照组。与对照组相比，ICG组的AL风险显著降低（RR：0.50，95%CI：0.37 - 0.67），住院时间缩短（SMD： - 0.31，95%CI： - 0.54 - 0.08）。同时，ICG在淋巴结检出方面表现明显更好（SMD：0.19，95%CI：0.02 - 0.36）。然而，比较手术时长（SMD： - 0.07，95%CI： - 0.30 - 0.15）和术中出血（SMD： - 0.16，95%CI： - 0.35 - 0.04）的含量时，未发现统计学意义。此外，术后发病率的汇总分析无统计学意义（RR：0.79，95%CI：0.58 - 1.08）。AL的亚组分析结果表明，AL可能存在地区差异（RR：0.50，95%CI：0.37 - 0.67）但术后发病率不存在地区差异（RR：0.79，95%CI：0.58 - 1.08）。总之，ICG在腹腔镜结直肠手术中的应用可有效降低AL、改善淋巴结检出情况并缩短住院时间。然而，需要更多多中心大样本随机对照试验来进一步证实其优势。该荟萃分析已在国际前瞻性注册系统（PROSPERO）注册（注册号：CRD42022288054）。
