Use of intraoperative ICG fluorescence angiography to reduce anastomotic leak in left‐sided colorectal resections: A systematic review and meta‐analysis of RCTs

AIM: Anastomotic leak remains a serious complication after left-sided colorectal resection with substantial morbidity, mortality and healthcare costs. This systematic review and meta-analysis evaluated whether intraoperative indocyanine green (ICG) fluorescence angiography reduces anastomotic leak rates in patients undergoing left-sided colorectal resections. METHODS: A systematic search of major databases and trial registries was conducted for RCTs comparing ICG angiography with standard visual assessment in adults undergoing elective left-sided colorectal resection. The primary outcomes were overall and clinically significant (ISGRC Grade B/C) anastomotic leak. Risk ratios (RRs) were pooled using a random-effects model. Risk of bias was assessed with the Cochrane ROB2 tool. RESULTS: = 0%). Assuming a 10% baseline leak rate, ICG prevents one leak per 27 patients treated. Subgroup analysis showed benefit even when ICG did not prompt surgical plan modification (RR 0.67, 95% CI 0.50-0.90). Between-study heterogeneity was negligible across all analyses. ICG use did not prolong operating time and has reduced postoperative complications (RR 0.88, 95% CI 0.73-1.05). CONCLUSION: Intraoperative ICG fluorescence angiography significantly reduces anastomotic leak rates after left-sided colorectal resection, with consistent benefit across diverse surgical settings. The technology is practical and does not prolong operating time. ICG angiography should be considered a valuable adjunct in left-sided colorectal resections.