Background: The primary treatment for colorectal cancer, which is very prevalent, is surgery. Anastomotic leaking poses a significant risk following surgery. Intestinal perfusion can be objectively and instantly assessed with indocyanine green fluorescence imaging, which may lower leakage rates and enhance surgical results.
Results: This meta-analysis includes 4047 patients from eight investigations (2026 indocyanine green (ICG) group, 2021 non-ICG group). Overall anastomotic leak risk was considerably decreased with ICG use (risk ratio (RR) = 0.66; 95% CI: 0.54-0.81; p < 0.0001) and showed no heterogeneity (I2 = 0%). There was no heterogeneity (I2 = 0%) in the Grade A leakage occurrence, which was considerably lower in the ICG group (RR = 0.34; 95% CI: 0.16-0.72; p = 0.005). With little heterogeneity (I2 = 8.6%), combined leakage grades also supported ICG use (RR = 0.54; 95% CI: 0.35-0.84; p = 0.006). ICG was associated with a substantial decrease in Clavien-Dindo Grade I complications (RR = 0.67; 95% CI: 0.49-0.92; p = 0.01) without heterogeneity (I2 = 0%). Initial postoperative hospital stays, mechanical ileus, paralytic ileus, and abdominal bleeding did not differ significantly. Although there was no heterogeneity (I2 = 0%), sensitivity analysis showed that the ICG group had a substantially longer postoperative stay (MD = 0.27; 95% CI 0.05-0.49; p = 0.02) and significantly fewer wound infections (RR = 0.17; 95% CI 0.04-0.76; p = 0.02). With noteworthy heterogeneity (I2 = 70%), the ICG group’s operating time was significantly longer (MD = 8.26 min; 95% CI 0.52-16.00; p = 0.04).
Conclusion: Although indocyanine green fluorescence imaging may marginally lengthen the recovery period and duration of operation, it dramatically lowers anastomotic leakage and wound infections following colorectal surgery, enhancing results.
