AUTHOR=Hong Zhi-Nuan , Huang Liqin , Zhang Weiguang , Kang Mingqiang 

TITLE=Indocyanine Green Fluorescence Using in Conduit Reconstruction for Patients With Esophageal Cancer to Improve Short-Term Clinical Outcome: A Meta-Analysis

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.847510

DOI=10.3389/fonc.2022.847510

ISSN=2234-943X

ABSTRACT=Objectives This meta-analysis aimed to evaluate the short-term safety and efficacy of indocyanine green (ICG) fluorescence using in gastric reconstruction to determine a suitable anastomotic position during esophagectomy. 
Methods The Preferred Reporting Items for Systematic reviews and Meta-Analyzes 2020 (PRISMA) has been followed for this analysis.
Results A total of 9 publications including 1162 patients were included. The operation time, and intraoperative blood loss were comparable in ICG group and control group. There was also no significant difference in overall postoperative mortality, reoperation, arrhythmia, vocal cord paralysis, pneumonia, surgical wound infection. ICG group had a 2.66day reduction in postoperative stay. The overall anastomotic leak (AL) was 17.6% (n =131) in the control group and 4.5% (n=19) in the ICG group with a relative risk (RR) 0.29(95% CI 0.18-0.47). Subgroup analysis showed the application of ICG in cervical anastomosis significantly reduced the incidence of AL (RR 0.31, 95% 0.18-0.52), but for intrathoracic anastomosis the RR 0.35 was not significant (95%CI 0.09-1.43). Compared to RR 0.35 in publications with sample size <50, sample size >50 had a lower RR 0.24(95% 0.12-0.48). Regarding intervention time of ICG, the application of ICG both before and after gastric construction had a better RR 0.25(95% 0.07-0.89). 
Conclusions The application of ICG fluorescence could effectively reduce the incidence of AL, and shorten postoperative hospital stay for patients undergoing cervical anastomosis, but not effective for patients undergoing intrathoracic anastomosis. The application of ICG fluorescence before and after gastric management can better prevent AL.