Intraoperative Use Of Indocyanine Green Fluorescence Angiography To Reduce Anastomotic Leakage After Rectal Cancer Surgery:a Meta-Analysis

Objective:To systematically evaluate whether intraoperative indocyanine green fluorescence angiography can reduce postoperative anastomotic leakage and postoperative complications in rectal cancer.Methods:The databases of PubMed,Cochrane Library,web of science,CNKI,VIP,and Wanfang were searched to retrieve studies on the intraoperative application of indocyanine green fluorescence angiography(ICG FA)to reduce postoperative anastomotic leakage in rectal cancer,and the retrieval dates were limited to July 2020.The quality evaluation and data extraction of the literatures meeting the screening criteria were performed,and the Review Manager 5.3 software was used for statistical analysis.Results:(1)Results of the search of the literature: 16 relevant literatures were finally included,including 1 RCT study and 15 NRCT studies.There were 3953 patients,including 1634 patients in the ICG group and 2319 patients in the non-ICG group.(2)Results of Meta-analysis.1.Incidence of anastomotic leakage: The incidence of anastomotic leakage in ICG group was lower than that in non-ICG group(OR=0.33,95% CI :0.25-0.44,P<0.05).2.Incidence of Total complication: Incidence of the total complication in ICG group was lower than that in non-ICG group(OR=0.57,95% CI :0.44-0.75,P<0.05).3.Incidence of incision infection: There was no significant difference in the incidence of incision infection between the experimental group and the control group,but the incidence of incision infection was slightly higher in ICG group(OR=1.17,95%CI :0.48-2.85,P>0.05).4.Incidence of anastomotic bleeding: There was no significant difference in the incidence of incision infection between the experimental group and the control group,but the incidence of anastomotic bleeding was increased in ICG group(OR=2.0,95%CI :0.53-7.47,P>0.05).5.Incidence of intestinal obstruction: There was no significant difference in the incidence of incision infection between the experimental group and the control group,but the incidence of intestinal obstruction in ICG group was slightly lower(OR=0.92,95% CI :0.35-2.39,P>0.05).6.Incidence of reoperation: There was no significant difference in the incidence of incision infection between the experimental group and the control group,but the incidence of reoperation was slightly lower in the ICG group(OR=0.35,95% CI :0.12-1.0,P=0.05).7.Incidence of ileostomy: There was no significant difference in the incidence of incision infection between the experimental group and the control group,the incidence of ileostomy was slightly higher in ICG group(OR=1.01,95% CI :0.79-1.27,P>0.05).8.Length of stay: There was no significant difference in the incidence of incision infection between the experimental group and the control group,but the length of stay in ICG group was reduced(WMD=0.06,95% CI :-0.43-0.56,P>0.05).Conclusion:Intraoperative use of indocyanine green fluorescence angiography can significantly reduce the incidence of postoperative anastomotic leakage and total complications in rectal cancer.