Assessment of intraoperative use of indocyanine green fluorescence imaging on the incidence of anastomotic leakage after
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REVIEW
Assessment of intraoperative use of indocyanine green fluorescence imaging on the incidence of anastomotic leakage after rectal cancer surgery: a PRISMA‑compliant systematic review and meta‑analysis M. Song1 · J. Liu1 · D. Xia2 · H. Yao2 · G. Tian1 · X. Chen2 · Y. Liu2 · Y. Jiang2 · Z. Li2 Received: 23 April 2020 / Accepted: 22 August 2020 © Springer Nature Switzerland AG 2020
Abstract Background The current data on the intraoperative use of indocyanine green (ICG) fluorescence imaging to reduce the anastomotic leak (AL) rate in rectal cancer surgery remain controversial. The aim of this systematic review and meta-analysis was to evaluate the efficacy of ICG fluorescence imaging in decreasing the AL rate after rectal cancer surgery. Methods Studies comparing ICG fluorescence imaging with standard care in patients with rectal cancer were systematically searched from PubMed, Embase, Web of Science and Cochrane Library through January 2020. The current meta-analysis was performed according to the preferred reporting items for systematic review and meta-analysis guidelines. A pooled analysis was performed for the available data regarding the baseline features, AL rate and other surgical outcomes. RevMan version 5.3 software was used for the present meta-analysis. Results Nine studies with a total of 2088 patients with rectal cancer (926 in the ICG group and 1162 in the control group) were included in the present study. In the pooled analysis, the available patient and tumour-related baseline data were all comparable and without significant heterogeneity. In the present pooled analysis, the AL rate in the ICG group was significantly lower (OR 0.34; 95% CI 0.22–0.52; p 50% indicates significant heterogeneity. For this, a random-effects model was used; otherwise, a fixed-effects model was performed. For the assessment of publication bias, a funnel plot was conducted. A p value 0.05 in the incorporated analysis. Meanwhile, those variables were all comparable between the ICG and control groups analysed by the fixed-effects model. Furthermore, the baseline parameters between the two groups were statistically insignificant in each single study.
Outcome assessment ICG use in altering the surgical plan and AL rate The primary outcome of this study was to assess the use of ICG on the incidence of AL after rectal cancer surgery. Ultimately, 9 studies (2088 patients) reporting this matter were included in our meta-analysis. Among these patients, the rate
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Techniques in Coloproctology
Table 1 Characteristics of studies Reference
Country Study interval
Boni [18]
Italy
Hasegawa [19]
Japan
Ishii [9]
Japan
Study design
Sample size Operation ICG dos(I:C) method age
ICG imaging Change of Funding support system surgical plan (%)
S; R I:2014– 2015; C:2012– 2013 S; R I:2016– 2017; C:2007– 2016 S; R I:2017– 2018; C:2014– 2018
80 (42:38)
Laparoscopic LAR
5 cc of 0.2 mg/ kg
d-Light
from 4.7 Storz®
NA
420 (141:279)
5.0 mg
IMAGE1 17 S™ system
NA
5.0 mg
1588/1688 AIM laparoscope
5.2
NA
Jafari [20
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