Impact of fluorescence angiography on anastomotic leak and complication rate in colorectal surgery: A systematic review and meta-analysis of randomized controlled trials.

Abstract

<h4>Objective</h4>Anastomotic leak occurs in 8.1% of right colectomies and up to 17.1% of low anterior resections. Fluorescence angiography has gained acceptance in recent years as a method for assessing anastomosis vascularization, a key element implicated in anastomotic leak. Our objective was to perform a systematic review and meta-analysis of randomized controlled trials on the effect of fluorescence angiography on anastomotic leak and postoperative morbidity.<h4>Methods</h4>A systematic review was performed on Medline, Embase and CENTRAL according to the PRISMA statement until 16 March 2025. Randomized controlled trials in English that compared fluorescence angiography with standard care were considered eligible. Articles were screened, bias was detected, data were extracted, pooled and analysed.<h4>Results</h4>Among 477 identified studies, 401 were retained for screening but only eight were included in the quantitative analysis (3999 patients). Fluorescence angiography was significantly protective against anastomotic leak, with an odds ratio of 0.64 (95% CI: 0.39-0.98, I²: 0%, p < 0.0001) and a reduction in risk of 4 percentage points (95% CI: -0.05 to 0.02, I²: 0%, p < 0.0001). When analysis was restricted to colorectal anastomosis, the effect of fluorescence angiography on anastomotic leak was maintained (OR 0.59, 95% CI 0.44-0.79, I²: 0%, p < 0.0005). However, fluorescence angiography did not reduce postoperative morbidity compared with the control group.<h4>Conclusion</h4>High-quality evidence shows that fluorescence angiography reduces the rate of anastomotic leak in colorectal surgery with a decrease in the incidence of 4 percentage points.