Correlation Between Intraoperative ICG Fluorescence Angiography And Postoperative Anastomotic Leakage In Rectal Cancer:A Meta-analysis

Objectives:To investigate the clinical practicability and safety of intraoperative indocyanine green(ICG)fluorescein angiography in patients with rectal cancer,and to evaluate the effect of ICG on anastomotic leakage(AL)after rectal cancer surgery.Methods:Search Pub Med,EMBASE,Web of Science,Cochrane Library,Wanfang Database,China Biology Medicine Disc(CBM),China National Knowledge Infrastructure(CNKI),China Science and Technology Journal Database(VIP)published between January 1,2000 and December 25,2020,comparing the use of ICG fluorescein angiography and non-use of ICG fluorescein angiography during rectal cancer surgery,using Rev Man 5.3 software performs meta-analysis to compare the incidence of anastomotic leakage,change in resection of proximal stump in the two treatments,surgical site infection(SSI)incidence,intestinal obstruction incidence,intraoperative blood transfusion,and urinary tract infection,urinary retention,intraoperative stoma,reoperation rate,operation time.Results:This study included 12 retrospective studies,a total of 2831 patients,1170 cases(41.3%)used ICG fluorescein angiography during the operation,as the ICG group;1661 cases(58.7%)did not use ICG fluorescein angiography during the operation,as the control group.Comparing the baseline data of age,gender,preoperative radiotherapy and chemotherapy,and body mass index(BMI)included in the study,the results showed that there was no significant difference in baseline data between the two groups(P>0.05).Meta-analysis results showed that compared with the control group,the incidence of anastomotic leakage[OR=0.28,95%CI(0.20,0.39),P<0.00001] in the ICG group were lower,the change rate of the preresection line was increased(OR = 27.35,95% CI(11.23,66.62),P<0.00001)in the ICG group,while the incidence of SSI [OR=0.95,95%CI(0.49,1.84),P=0.88],the incidence of intestinal obstruction [OR =1.09,95%CI(0.50,2.37),P=0.83],reoperation rate[OR=0.69,95%CI(0.41,1.18),P=0.18],operation time [SMD=-0.06,95%CI(-0.39,0.27),P=0.71],intraoperative blood transfusion [OR=0.84,95%CI(0.32,2.26),P=0.74],intraoperative stoma [OR=1.23,95%CI(0.79,1.93),P=0.36],urinary tract infection [OR=1.16,95%CI(0.42,3.19),P=0.78] and urinary retention [OR=0.79,95%CI(0.31,2.01),P=0.61] between the two groups,the differences were not statistically significant.Conclusion:The intraoperative use of ICG fluorescence angiography is safe and reliable.Compared with the control group,ICG fluorescein angiography in operation,the incidence of surgical site infection,the incidence of intestinal obstruction,the rate of reoperation,the operation time,intraoperative blood transfusion,intraoperative stoma,urinary tract infection and urinary retention did not increase.Intraoperative use of ICG fluorescein angiography can accurately assess the blood flow of the anastomosis,and timely change the preresection line for patients with poor blood supply,so as to effectively reduce the risk of anastomotic leakage.