Fluorescence angiography likely protects against anastomotic leak in colorectal surgery: a systematic review and meta-analysis of randomised controlled trials.
Anastomotic leak
Angiography
Bowel division
Colectomy
Colorectal surgery
Ischaemia
Prevention
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
Oct 2022
Oct 2022
Historique:
received:
27
10
2021
accepted:
08
04
2022
pubmed:
5
5
2022
medline:
23
9
2022
entrez:
4
5
2022
Statut:
ppublish
Résumé
Observational studies have shown that fluorescence angiography (FA) decreases the incidence of anastomotic leak (AL) in colorectal surgery, but high-quality pooled evidence was lacking. Therefore, we aimed at confirming this preliminary finding using a systematic review and meta-analysis of randomised controlled trials (RCTs) in the field. MEDLINE, Embase and CENTRAL were searched for RCTs assessing the effect of intra-operative FA versus standard assessment of bowel perfusion on the incidence of AL of colorectal anastomosis. The systematic review complied with the PRISMA 2020 and AMSTAR2 recommendations and was registered in PROSPERO. Pooled relative risk (RR) and pooled risk difference (RD) were obtained using models with random effects. Heterogeneity was assessed using the Q-test and quantified using the I One hundred and eleven articles were screened, 108 were excluded and three were kept for inclusion. The three included RCTs compared assessment of the perfusion of the bowel during creation of a colorectal anastomosis using FA versus standard practice. In meta-analysis, FA was significantly protective against AL (3 RCTs, 964 patients, RR: 0.67, 95% CI: 0.46 to 0.99, I The effect of FA on prevention of AL in colorectal surgery exists but is potentially of small magnitude. Considering the potential magnitude of effect of FA, we advise that future RCTs have an adequate sample size, include a cost-benefit analysis of the technique and better define the subpopulation who could benefit from FA.
Identifiants
pubmed: 35508666
doi: 10.1007/s00464-022-09255-1
pii: 10.1007/s00464-022-09255-1
pmc: PMC9485176
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
7775-7780Informations de copyright
© 2022. The Author(s).
Références
European Society of Coloproctology collaborating group (2017) The relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit. Colorectal Dis. Online ahead of print.
Denost Q, Rouanet P, Faucheron JL et al (2017) To drain or not to drain infraperitoneal anastomosis after rectal excision for cancer: the GRECCAR 5 randomized trial. Ann Surg 265(3):474–480
doi: 10.1097/SLA.0000000000001991
Meyer J, Naiken S, Christou N et al (2019) Reducing anastomotic leak in colorectal surgery: the old dogmas and the new challenges. World J Gastroenterol 25(34):5017–5025
doi: 10.3748/wjg.v25.i34.5017
Gaines S, Shao C, Hyman N, Alverdy JC (2018) Gut microbiome influences on anastomotic leak and recurrence rates following colorectal cancer surgery. Br J Surg 105(2):e131–e141
doi: 10.1002/bjs.10760
Ris F, Yeung T, Hompes R, Mortensen NJ (2015) Enhanced reality and intraoperative imaging in colorectal surgery. Clin Colon Rectal Surg 28(3):158–164
doi: 10.1055/s-0035-1555007
Shen R, Zhang Y, Wang T (2018) Indocyanine green fluorescence angiography and the incidence of anastomotic leak after colorectal resection for colorectal cancer: a meta-analysis. Dis Colon Rectum 61(10):1228–1234
doi: 10.1097/DCR.0000000000001123
Liu D, Liang L, Liu L, Zhu Z (2021) Does intraoperative indocyanine green fluorescence angiography decrease the incidence of anastomotic leakage in colorectal surgery? A systematic review and meta-analysis. Int J Colorectal Dis 36(1):57–66
doi: 10.1007/s00384-020-03741-5
Lin J, Zheng B, Lin S, Chen Z, Chen S (2021) The efficacy of intraoperative ICG fluorescence angiography on anastomotic leak after resection for colorectal cancer: a meta-analysis. Int J Colorectal Dis 36(1):27–39
doi: 10.1007/s00384-020-03729-1
Trastulli S, Munzi G, Desiderio J, Cirocchi R, Rossi M, Parisi A (2021) Indocyanine green fluorescence angiography versus standard intraoperative methods for prevention of anastomotic leak in colorectal surgery: meta-analysis. Br J Surg 108(4):359–372
doi: 10.1093/bjs/znaa139
Ris F, Liot E, Buchs NC et al (2018) Multicentre phase II trial of near-infrared imaging in elective colorectal surgery. Br J Surg 105(10):1359–1367
doi: 10.1002/bjs.10844
Arezzo A, Bonino MA, Ris F et al (2020) Intraoperative use of fluorescence with indocyanine green reduces anastomotic leak rates in rectal cancer surgery: an individual participant data analysis. Surg Endosc 34(10):4281–4290
doi: 10.1007/s00464-020-07735-w
Song M, Liu J, Xia D et al (2021) 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 25(1):49–58
doi: 10.1007/s10151-020-02335-1
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(1):15–23
doi: 10.1007/s10151-017-1731-8
Jafari MD, Wexner SD, Martz JE et al (2015) Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg 220(1):82-92 e1
doi: 10.1016/j.jamcollsurg.2014.09.015
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(1):53–60
doi: 10.1007/s00464-019-06730-0
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. Colorectal Dis 22(9):1147–1153
doi: 10.1111/codi.15037
Jafari MD, Pigazzi A, McLemore EC et al (2021) Perfusion assessment in left-sided/low anterior resection (PILLAR III): a randomized, controlled, parallel, multicenter study assessing perfusion outcomes with PINPOINT near-infrared fluorescence imaging in low anterior resection. Dis Colon Rectum 64(8):995–1002
doi: 10.1097/DCR.0000000000002007
Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71
doi: 10.1136/bmj.n71
Sterne JAC, Savovic J, Page MJ et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898
doi: 10.1136/bmj.l4898
GRADEpro GDT: GRADEpro Guideline Development Tool [Software]. McMaster University and Evidence Prime, 2021. Available from gradepro.org.
Keller DS, Hompes R (2021) PILLAR of surgical decision-making? Perhaps not without more evidence. Dis Colon Rectum 64(8):921–922
doi: 10.1097/DCR.0000000000002098
Meyer J, Schiltz B, Balaphas A et al (2021) How do Swiss surgeons perform fluorescence angiography in colorectal surgery? Tech Coloproctol 25(5):657–658
doi: 10.1007/s10151-021-02427-6
Lutken CD, Achiam MP, Svendsen MB, Boni L, Nerup N (2020) Optimizing quantitative fluorescence angiography for visceral perfusion assessment. Surg Endosc 34(12):5223–5233
doi: 10.1007/s00464-020-07821-z