Kazi Mufaddal, Ajith Atul, Bhoyar Abhiram, Yelamanchi Raghav
Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
Department of Surgical Oncology, Advanced Centre for the Treatment, Research, and Education in Cancer, Navi Mumbai, India.
ANZ J Surg. 2024 Dec;94(12):2128-2136. doi: 10.1111/ans.19201. Epub 2024 Aug 16.
The objective of this systematic review and meta-analysis was to pool randomized trials of patients undergoing left-sided colorectal anastomosis, comparing the use of fluorescence perfusion imaging versus visual inspection in reducing anastomotic leaks.
Databases searched included PubMed, Cochrane Library, Scopus, CINHAL (EBSCO), and Google Scholar based on the concepts: randomized, colorectal, anastomotic leak, and fluorescence imaging. The risk of bias was assessed using RoB2 and the certainty of the evidence with the GRADE Pro tool. The analysis used the log odds ratio for dichotomous data with 95% confidence intervals. Back-transformation of the log odds to odds ratio was performed for the summary of findings. All syntheses used the Random-effects model.
Six randomized trials were included with 1949 patients and 204 events (leaks). Three trials included exclusively rectal cancer patients, while the other three involved benign and malignant pathologies of the sigmoid and rectum. The use of ostomy and preoperative radiation was variable. None of the studies had a high risk of bias. The pooled odds ratio for anastomotic leak reduction with Indocyanine Green (ICG) fluorescence was 0.586 (95% CI: 0.434-0.792). An absolute reduction of 4.7% in leak rates was observed, with no statistical heterogeneity (I = 0; p = 0.529). Due to clinical heterogeneity, the quality of evidence was rated moderate.
The use of ICG is associated with reduced leak rates following left-sided colorectal anastomosis with moderate confidence. ICG may be considered a standard of care given the clinically significant benefit in decreasing anastomotic leaks.
本系统评价和荟萃分析的目的是汇总接受左侧结直肠吻合术患者的随机试验，比较使用荧光灌注成像与目视检查在减少吻合口漏方面的效果。
基于随机、结直肠、吻合口漏和荧光成像等概念，检索了包括PubMed、Cochrane图书馆、Scopus、CINHAL（EBSCO）和谷歌学术在内的数据库。使用RoB2评估偏倚风险，并使用GRADE Pro工具评估证据的确定性。分析使用二分类数据的对数比值比及９５％置信区间。对结果摘要进行对数比值向比值比的逆转换。所有综合分析均采用随机效应模型。
纳入了６项随机试验，共1949例患者和204例（吻合口漏）事件。３项试验仅纳入直肠癌患者，另外３项涉及乙状结肠和直肠的良性及恶性病变。造口术和术前放疗的使用情况各不相同。所有研究均无高偏倚风险。吲哚菁绿（ICG）荧光成像用于减少吻合口漏的合并比值比为0.586（95％CI：0.434-0.792）。观察到漏率绝对降低了4.7％，无统计学异质性（I²＝0；p＝0.529）。由于存在临床异质性，证据质量被评为中等。
中等可信度下，ICG的使用与左侧结直肠吻合术后漏率降低相关。鉴于ICG在减少吻合口漏方面具有显著临床益处，可考虑将其作为一种治疗标准。
