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07.01.2021 | Systematic Reviews and Meta-analyses

Indocyanine green fluorescence angiography prevents anastomotic leakage in rectal cancer surgery: a systematic review and meta-analysis

verfasst von: Hua-Yang Pang, Xiao-Long Chen, Xiao-Hai Song, Danil Galiullin, Lin-Yong Zhao, Kai Liu, Wei-Han Zhang, Kun Yang, Xin-Zu Chen, Jian-Kun Hu

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 2/2021

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Abstract

Background

The role of intraoperative use of indocyanine green (ICG) fluorescence angiography (ICGFA) to prevent anastomotic leakage (AL) in rectal cancer surgery remains controversial.

Methods

The systematic review for studies evaluating ICGFA in patients undergoing rectal cancer surgery in PubMed, Embase, Web of Science, and the Cochrane Library was performed up to April 30, 2020. The primary outcome was the incidence of AL. The analysis was performed using RevMan v5.3 and Stata v12.0 software.

Results

Eighteen studies comprising 4038 patients were included. In the present meta-analysis, intraoperative use of ICGFA markedly reduced AL rate (OR = 0.33; 95% CI: 0.24–0.45; P < 0.0001; I² = 0%) in rectal cancer surgery, which was still significant in surgeries limited to symptomatic AL (OR = 0.44; 95% CI: 0.31–0.64; P < 0.0001; I² = 22%). This intervention was also associated with shorter postoperative stays (MD = − 1.27; 95% CI: − 2.42 to − 0.13; P = 0.04; I² = 60%). However, reoperation rate (OR = 0.61; 95% CI: 0.34–1.10; P = 0.10; I² = 6%), ileus rate (OR = 1.30; 95% CI: 0.60–2.82; P = 0.51; I² = 56%), and surgical site infection rate (OR = 1.40; 95% CI: 0.62–3.20; P = 0.42; I² = 0%) were not significantly different between the two groups.

Conclusion

The use of ICGFA was associated with a lower AL rate after rectal cancer resection. However, more multi-center RCTs with large sample size are required to further verify the value of ICGFA in rectal cancer surgery.

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Fukada M, Matsuhashi N, Takahashi T, Imai H, Tanaka Y, Yamaguchi K, Yoshida K (2019) Risk and early predictive factors of anastomotic leakage in laparoscopic low anterior resection for rectal cancer. World J Surg Oncol 17:178PubMedPubMedCentralCrossRef

Hoshino N, Hida K, Sakai Y, Osada S, Idani H, Sato T, Takii Y, Bando H, Shiomi A, Saito N (2018) Nomogram for predicting anastomotic leakage after low anterior resection for rectal cancer. Int J Color Dis 33:411–418CrossRef

Kang CY, Halabi WJ, Chaudhry OO, Nguyen V, Pigazzi A, Carmichael JC, Mills S, Stamos MJ (2013) Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg 148:65–71PubMedCrossRef

Chadi SA, Fingerhut A, Berho M, DeMeester SR, Fleshman JW, Hyman NH, Margolin DA, Martz JE, McLemore EC, Molena D, Newman MI, Rafferty JF, Safar B, Senagore AJ, Zmora O, Wexner SD (2016) Emerging trends in the etiology, prevention, and treatment of gastrointestinal anastomotic leakage. J Gastrointest Surg 20:2035–2051PubMedCrossRef

Vallance A, Wexner S, Berho M, Cahill R, Coleman M, Haboubi N, Heald RJ, Kennedy RH, Moran B, Mortensen N, Motson RW, Novell R, O'Connell PR, Ris F, Rockall T, Senapati A, Windsor A, Jayne DG (2017) A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery. Color Dis 19:O1–o12CrossRef

Blanco-Colino R, Espin-Basany E (2018) Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Tech Coloproctol 22:15–23PubMedCrossRef

Ellebaek MB, Rahr HB, Boye S et al (2019) Detection of early anastomotic leakage by intraperitoneal microdialysis after low anterior resection for rectal cancer: a prospective cohort study. Color Dis 21:1387–1396CrossRef

Pommergaard HC, Gessler B, Burcharth J, Angenete E, Haglind E, Rosenberg J (2014) Preoperative risk factors for anastomotic leakage after resection for colorectal cancer: a systematic review and meta-analysis. Color Dis 16:662–671CrossRef

Vignali A, Gianotti L, Braga M, Radaelli G, Malvezzi L, Carlo VD (2000) Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak. Dis Colon Rectum 43:76–82PubMedCrossRef

10.

Hirst NA, Tiernan JP, Millner PA, Jayne DG (2014) Systematic review of methods to predict and detect anastomotic leakage in colorectal surgery. Color Dis 16:95–109CrossRef

11.

Degett TH, Andersen HS, Gögenur I (2016) Indocyanine green fluorescence angiography for intraoperative assessment of gastrointestinal anastomotic perfusion: a systematic review of clinical trials. Langenbeck's Arch Surg 401:767–775CrossRef

12.

Keller DS, Ishizawa T, Cohen R, Chand M (2017) Indocyanine green fluorescence imaging in colorectal surgery: overview, applications, and future directions. Lancet Gastroenterol Hepatol 2:757–766PubMedCrossRef

13.

Alander JT, Kaartinen I, Laakso A et al (2012) A review of indocyanine green fluorescent imaging in surgery. Int J Biomed Imaging 2012:940585PubMedPubMedCentralCrossRef

14.

Song M, Liu J, Xia D, Yao H, Tian G, Chen X, Liu Y, Jiang Y, Li Z (2020) 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. Tech Coloproctol

15.

Liu D, Liang L, Liu L, Zhu Z (2020) Does intraoperative indocyanine green fluorescence angiography decrease the incidence of anastomotic leakage in colorectal surgery? A systematic review and meta-analysis. Int J Color Dis

16.

Shen Y, Yang T, Yang J, Meng W, Wang Z (2020) Intraoperative indocyanine green fluorescence angiography to prevent anastomotic leak after low anterior resection for rectal cancer: a meta-analysis. ANZ J Surg 90:2193–2200PubMedCrossRef

17.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62:e1–e34PubMedCrossRef

18.

Lin J, Zheng B, Lin S, Chen Z, Chen S (2020) The efficacy of intraoperative ICG fluorescence angiography on anastomotic leak after resection for colorectal cancer: a meta-analysis. Int J Color Dis

19.

Cumpston M, Li T, Page MJ et al (2019) Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev 10:Ed000142PubMed

20.

Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605PubMedCrossRef

21.

McGrath S, Zhao X, Steele R et al (2020) Estimating the sample mean and standard deviation from commonly reported quantiles in meta-analysis. Stat Methods Med Res 962280219889080

22.

Atkins D, Best D, Briss PA et al (2004) Grading quality of evidence and strength of recommendations. Bmj 328:1490PubMedCrossRef

23.

Alekseev M, Rybakov E, Shelygin Y, Chernyshov S, Zarodnyuk I (2020) A study investigating the perfusion of colorectal anastomoses using fluorescence angiography: results of the FLAG randomized trial. Color Dis 22:1147–1153CrossRef

24.

Bonadio L, Iacuzzo C, Cosola D, Cipolat Mis T, Giudici F, Casagranda B, Biloslavo A, de Manzini N (2020) Indocyanine green-enhanced fluorangiography (ICGf) in laparoscopic extraperitoneal rectal cancer resection. Updat Surg 72:477–482CrossRef

25.

Boni L, Fingerhut A, Marzorati A, Rausei S, Dionigi G, Cassinotti E (2017) Indocyanine green fluorescence angiography during laparoscopic low anterior resection: results of a case-matched study. Surg Endosc 31:1836–1840PubMedCrossRef

26.

Brescia A, Pezzatini M, Romeo G, Cinquepalmi M, Pindozzi F, Dall’Oglio A, Gasparrini M, Lazar F (2018) Indocyanine green fluorescence angiography: a new ERAS item. Updat Surg 70:427–432CrossRef

27.

De Nardi P, Elmore U, Maggi G et al (2020) Intraoperative angiography with indocyanine green to assess anastomosis perfusion in patients undergoing laparoscopic colorectal resection: results of a multicenter randomized controlled trial. Surg Endosc 34:53–60PubMedCrossRef

28.

Dinallo AM, Kolarsick P, Boyan WP, Protyniak B, James A, Dressner RM, Arvanitis ML (2019) Does routine use of indocyanine green fluorescence angiography prevent anastomotic leaks? A retrospective cohort analysis. Am J Surg 218:136–139PubMedCrossRef

29.

Hasegawa H, Tsukada Y, Wakabayashi M, Nomura S, Sasaki T, Nishizawa Y, Ikeda K, Akimoto T, Ito M (2020) Impact of intraoperative indocyanine green fluorescence angiography on anastomotic leakage after laparoscopic sphincter-sparing surgery for malignant rectal tumors. Int J Color Dis 35:471–480CrossRef

30.

Impellizzeri HG, Pulvirenti A, Inama M et al (2020) Near-infrared fluorescence angiography for colorectal surgery is associated with a reduction of anastomotic leak rate. Updat Surg 72:991–998CrossRef

31.

Ishii M, Hamabe A, Okita K, Nishidate T, Okuya K, Usui A, Akizuki E, Satoyoshi T, Takemasa I (2020) Efficacy of indocyanine green fluorescence angiography in preventing anastomotic leakage after laparoscopic colorectal cancer surgery. Int J Color Dis 35:269–275CrossRef

32.

Jafari MD, Lee KH, Halabi WJ, Mills SD, Carmichael JC, Stamos MJ, Pigazzi A (2013) The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery. Surg Endosc 27:3003–3008PubMedCrossRef

33.

Kim JC, Lee JL, Yoon YS, Alotaibi AM, Kim J (2016) Utility of indocyanine-green fluorescent imaging during robot-assisted sphincter-saving surgery on rectal cancer patients. Int J Med Robot 12:710–717PubMedCrossRef

34.

Kin C, Vo H, Welton L, Welton M (2015) Equivocal effect of intraoperative fluorescence angiography on colorectal anastomotic leaks. Dis Colon Rectum 58:582–587PubMedCrossRef

35.

Kudszus S, Roesel C, Schachtrupp A, Hoer JJ (2010) Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage. Langenbeck's Arch Surg 395:1025–1030CrossRef

36.

Mizrahi I, Abu-Gazala M, Rickles AS, Fernandez LM, Petrucci A, Wolf J, Sands DR, Wexner SD (2018) Indocyanine green fluorescence angiography during low anterior resection for low rectal cancer: results of a comparative cohort study. Tech Coloproctol 22:535–540PubMedCrossRef

37.

Otero-Pineiro AM, de Lacy FB, Van Laarhoven JJ et al (2020) The impact of fluorescence angiography on anastomotic leak rate following transanal total mesorectal excision for rectal cancer: a comparative study. Surg Endosc

38.

Ris F, Liot E, Buchs NC, Kraus R, Ismael G, Belfontali V, Douissard J, Cunningham C, Lindsey I, Guy R, Jones O, George B, Morel P, Mortensen NJ, Hompes R, Cahill RA, the Near-Infrared Anastomotic Perfusion Assessment Network VOIR (2018) Multicentre phase II trial of near-infrared imaging in elective colorectal surgery. Br J Surg 105:1359–1367PubMedPubMedCentralCrossRef

39.

Shapera E, Hsiung RW (2019) Assessment of anastomotic perfusion in left-sided robotic assisted colorectal resection by Indocyanine green fluorescence angiography. Minim Invasive Surg 2019:3267217PubMedPubMedCentral

40.

Skrovina M, Bencurik V, Martinek L, Machackova M, Bartos J, Andel P, Stepanova E, Bunakova M, Vomackova K (2020) The significance of intraoperative fluorescence angiography in miniinvasive low rectal resections. Wideochir Inne Tech Maloinwazyjne 15:43–48PubMed

41.

Tsang YP, Leung LA, Lau CW, Tang CN (2020) Indocyanine green fluorescence angiography to evaluate anastomotic perfusion in colorectal surgery. Int J Color Dis 35:1133–1139CrossRef

42.

Wada T, Kawada K, Hoshino N, Inamoto S, Yoshitomi M, Hida K, Sakai Y (2019) The effects of intraoperative ICG fluorescence angiography in laparoscopic low anterior resection: a propensity score-matched study. Int J Clin Oncol 24:394–402PubMedCrossRef

43.

Watanabe J, Ishibe A, Suwa Y, Suwa H, Ota M, Kunisaki C, Endo I (2020) Indocyanine green fluorescence imaging to reduce the risk of anastomotic leakage in laparoscopic low anterior resection for rectal cancer: a propensity score-matched cohort study. Surg Endosc 34:202–208PubMedCrossRef

44.

Wojcik M, Doussot A, Manfredelli S, Duclos C, Paquette B, Turco C, Heyd B, Lakkis Z (2020) Intraoperative fluorescence angiography is reproducible and reduces the rate of anastomotic leak after colorectal resection for cancer: a prospective case-matched study. Color Dis 22:1263–1270CrossRef

45.

Kudszus S, Roesel C, Schachtrupp A, Hoeer JJ (2010) Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage. Langenbecks Arch Surg 395:1025–1030PubMedCrossRef

46.

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196PubMedCrossRef

47.

Ashraf SQ, Burns EM, Jani A, Altman S, Young JD, Cunningham C, Faiz O, Mortensen NJ (2013) The economic impact of anastomotic leakage after anterior resections in English NHS hospitals: are we adequately remunerating them? Color Dis 15:e190–e198CrossRef

48.

Lu ZR, Rajendran N, Lynch AC, Heriot AG, Warrier SK (2016) Anastomotic leaks after restorative resections for rectal cancer compromise cancer outcomes and survival. Dis Colon Rectum 59:236–244PubMedCrossRef

49.

Wang S, Liu J, Wang S, Zhao H, Ge S, Wang W (2017) Adverse effects of anastomotic leakage on local recurrence and survival after curative anterior resection for rectal Cancer: a systematic review and meta-analysis. World J Surg 41:277–284PubMedCrossRef

50.

D'Urso A, Agnus V, Barberio M et al (2020) Computer-assisted quantification and visualization of bowel perfusion using fluorescence-based enhanced reality in left-sided colonic resections. Surg Endosc

51.

Hayami S, Matsuda K, Iwamoto H, Ueno M, Kawai M, Hirono S, Okada K, Miyazawa M, Tamura K, Mitani Y, Kitahata Y, Mizumoto Y, Yamaue H (2019) Visualization and quantification of anastomotic perfusion in colorectal surgery using near-infrared fluorescence. Tech Coloproctol 23:973–980PubMedCrossRef

52.

Ishige F, Nabeya Y, Hoshino I, Takayama W, Chiba S, Arimitsu H, Iwatate Y, Yanagibashi H (2019) Quantitative assessment of the blood perfusion of the gastric conduit by Indocyanine green imaging. J Surg Res 234:303–310PubMedCrossRef

53.

Lütken CD, Achiam MP, Svendsen MB et al (2020) Optimizing quantitative fluorescence angiography for visceral perfusion assessment. Surg Endosc 34:5223–5233PubMedCrossRef

54.

Lütken CD, Achiam MP, Osterkamp J, Svendsen MB, Nerup N (2020) Quantification of fluorescence angiography: toward a reliable intraoperative assessment of tissue perfusion - a narrative review. Langenbeck's Arch Surg

Titel: Indocyanine green fluorescence angiography prevents anastomotic leakage in rectal cancer surgery: a systematic review and meta-analysis
verfasst von: Hua-Yang Pang
Xiao-Long Chen
Xiao-Hai Song
Danil Galiullin
Lin-Yong Zhao
Kai Liu
Wei-Han Zhang
Kun Yang
Xin-Zu Chen
Jian-Kun Hu
Publikationsdatum: 07.01.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Langenbeck's Archives of Surgery / Ausgabe 2/2021
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-020-02077-6

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