Summary Background Indocyanine green (ICG) fluorescence imaging is an emerging technology that might help decreasing anastomotic leakage (AL) rates. The aim of this study was to determine the usefulness of ICG fluorescence imaging for the prevention of AL after minimally invasive esophagectomy with intrathoracic anastomosis. Methods A systematic literature review of the MEDLINE and Cochrane databases was performed to identify all articles on totally minimally invasive Ivor Lewis esophagectomy. Studies were then divided into two groups based on the use or not of ICG for perfusion assessment. Primary outcome was anastomotic leak. Secondary outcomes included operative time, ICG-related adverse reactions, and mortality rate. A meta-analysis was conducted to estimate the overall weighted proportion and its 95% confidence interval (CI) for main outcomes. Results A total of 3,171 patients were included for analysis: 381 (12%) with intraoperative ICG fluorescence imaging and 2,790 (88%) without ICG. Mean patients’ age and proportion of males were similar between groups. Mean operative time was also similar between both groups (ICG: 354.8 vs. No-ICG: 354.1 minutes, P = 0.52). Mean ICG dose was 12 mg (5–21 mg). No ICG-related adverse reactions were reported. AL rate was 9% (95% CI, 5–17%) and 9% (95% CI, 7–12%) in the ICG and No-ICG groups, respectively. The risk of AL was similar between groups (odds ratio 0.85, 95% CI 0.53–1.28, P = 0.45). Mortality was 3% (95% CI, 1–9%) in patients with ICG and 2% (95% CI, 2–3%) in those without ICG. Median length of hospital stay was also similar between groups (ICG: 13.6 vs. No-ICG: 11.2 days, P = 0.29). Conclusion The use of ICG fluorescence imaging for perfusion assessment does not seem to reduce AL rates in patients undergoing minimally invasive esophagectomy with intrathoracic anastomosis.

中文翻译：

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吲哚菁绿 (ICG) 荧光成像预防全微创 Ivor Lewis 食管切除术吻合口漏：系统评价和荟萃分析

摘要背景 吲哚菁绿 (ICG) 荧光成像是一种新兴技术，可能有助于降低吻合口漏 (AL) 率。本研究的目的是确定 ICG 荧光成像在胸腔内吻合术微创食管切除术后预防 AL 的有效性。方法 对 MEDLINE 和 Cochrane 数据库进行系统文献回顾，以确定所有关于完全微创 Ivor Lewis 食管切除术的文章。然后根据是否使用 ICG 进行灌注评估，将研究分为两组。主要结果是吻合口漏。次要结局包括手术时间、ICG 相关不良反应和死亡率。进行了一项荟萃分析，以估计主要结果的总体加权比例及其 95% 置信区间 (CI)。结果共纳入 3171 例患者进行分析：381 例（12%）有术中 ICG 荧光成像，2790 例（88%）无 ICG。两组患者的平均年龄和男性比例相似。两组的平均手术时间也相似（ICG：354.8 vs. No-ICG：354.1 分钟，P = 0.52）。平均 ICG 剂量为 12 毫克（5-21 毫克）。未报告 ICG 相关的不良反应。ICG 组和无 ICG 组的 AL 率分别为 9%（95% CI，5-17%）和 9%（95% CI，7-12%）。各组之间 AL 的风险相似（优势比 0.85, 95% CI 0.53–1.28, P = 0.45）。有 ICG 的患者死亡率为 3%（95% CI，1-9%），没有 ICG 的患者死亡率为 2%（95% CI，2-3%）。组间住院时间的中位数也相似（ICG：13.6 与无 ICG：11.2 天，P = 0.29）。