ICG-FA for Anastomotic Leak Prevention During Minimally Invasive Colorectal Surgery: A Meta-analysis

Anastomotic leakage is a serious complication after colorectal surgery. Indocyanine green fluorescence angiography (ICG-FA) allows real-time perfusion assessment and may reduce leak rates; however, recent larger randomized clinical trials reported conflicting results. This meta-analysis aimed to clarify the effectiveness of ICG-FA in reducing anastomotic leakage and related complications following minimally invasive colorectal surgery.

We conducted a comprehensive search across the databases to identify relevant studies. The search results were imported into Covidence for article eligibility screening, and all relevant outcomes data were synthesized using risk ratios (RRs) or mean differences with 95% confidence intervals (CIs) in meta-analysis models using RevMan 5.4. CRD420251031138.

Six randomized clinical trials involving 3264 participants were included. ICG-FA significantly reduced the risk of overall anastomotic leakage (RR: 0.66, 95% CI [0.53-0.83], P = 0.0005) and complications (RR: 0.88, 95% CI [0.78-0.99], P = 0.03). Subgroup analysis showed a significant reduction in leakage for left-sided anastomoses (RR: 0.57, 95% CI [0.44-0.75], P < 0.0001) but not for right-sided ones (RR: 0.90, 95% CI [0.53-1.51], P = 0.68). No significant differences were found in Clavien-Dindo ≥3 complications, reoperation rates, or hospital stay. However, the ICG-FA group had a longer operation time (mean difference: 5.57, 95% CI [1.56-9.58], P = 0.006).

ICG-FA significantly reduces anastomotic leakage and overall complications in minimally invasive colorectal surgery, especially for left-sided anastomoses. However, its use is associated with a slightly longer operative time. Further research is needed to confirm its role in right-sided procedures and long-term outcomes.