The role of indocyanine green fluorescence angiography in the perioperative period for patients after colorectal surgery: a meta-analysis of propensity score-matched studies with trial sequential analysis.

INTRODUCTION

The utilization of Indocyanine Green (ICG) Fluorescence Angiography (FA) in colorectal surgery is gaining increasing traction. This manuscript employs meta-analysis, propensity score-matched (PSM), and trial sequential analysis (TSA) to compare the perioperative outcomes between colorectal cancer patients who underwent surgery with and without ICG FA.

MATERIALS AND METHODS

A thorough literature search was conducted across many databases, including PubMed, Embase, Cochrane Library, and Web of Science, from the foundation of each database to November 2024. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale. Meta-analysis was conducted utilizing R language software. The I statistic assessed heterogeneity, with subgroup analyses conducted. TSA was employed to validate the authenticity of the results, distinguishing between true and false positive or negative outcomes.

RESULTS

A total of 25 studies involving 6877 patients were analyzed, and all utilized PSM. Analysis of the results showed that compared with the Non-ICG group (control group), the ICG group had a low rate of anastomotic leakage (OR 0.50, 95% CI 0.42 to 0.61, P < 0.05), symptomatic anastomotic leakage (OR 0.32, 95% CI 0.21 to 0.49, P < 0.05), total postoperative complications (OR 0.79, 95% CI 0.66 to 0.95, P = 0.01), and reoperation (OR 0.33, 95% CI 0.17 to 0.65, P < 0.05), and a shorter mean postoperative hospital stay (MD - 0.91, 95% CI - 1.41 to - 0.41, P < 0.05).

CONCLUSION

ICG FA significantly reduces the incidence of anastomotic leaks, symptomatic anastomotic leaks, total postoperative complications, and the need for reoperation while decreasing postoperative hospital stay.