Does fluorescence angiography reduce the incidence of anastomotic leak in colorectal surgery: A systematic review and metaanalysis of randomized controlled trials

Background: Observational studies have shown that fluorescence angiography (FA) decreases the incidence of anastomotic leak (AL) in colorectal surgery, but high-quality pooled evidence is lacking. Methods: 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. Pooled relative risk (RR) and pooled risk difference (RD) were obtained using models with random effects. Results: Two-hundred forty-eight articles were screened, 245 were excluded and 3 were kept for inclusion. The three included RCTs compared assessment of the perfusion of the bowel during confection of a colorectal anastomosis using FA versus standard practice. In meta-analysis, FA was significantly protective against anastomotic leak (3 RCTs, 964 patients, RR: 0.67, 95%CI: 0.46 to 0.99, I2: 0%, p = 0.04). The incidence of AL was non-significantly decreased by 4 percentage points (95%CI:-0.08 to 0, I2: 8%, p = 0.06) when using FA. Conclusion: The effect of FA on prevention of AL in colorectal surgery exists but is potentially of small magnitude.