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Meta-Analysis
. 2025 Oct;27(10):e70236.
doi: 10.1111/codi.70236.

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

Alexandre Balaphas  1   2 , Marwan Julien Sleiman  1 , Guillaume Meurette  1   2 , Emilie Liot  1   2 , Christian Toso  1   2 , Frédéric Ris  1   2 , Jeremy Meyer  1
Affiliations
Meta-Analysis

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

Alexandre Balaphas et al. Colorectal Dis. 2025 Oct.

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: anastomotic leak; angiography; bowel division; colectomy; colorectal surgery; ischemia; prevention.

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Conflict of interest statement

The authors disclose no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart according to the PRISMA 2020 statement.
FIGURE 2
FIGURE 2
Meta‐analysis of fluorescence angiography versus the control for anastomotic leak expressed as the odds ratio. Forest plot comparing fluorescence angiography versus the control for anastomotic leak. Each horizontal bar summarizes a study. The bars represent 95% confidence intervals. The grey squares indicate each of the studies' weights in the meta‐analysis. The diamond in the lower part of the graph depicts the pooled estimate along with 95% confidence intervals. (A) Results are represented as odds ratios. (B) Results represented as risk differences. The odds ratio (OR) was obtained via models with random effects (Mantel–Haenszel). Heterogeneity was assessed via the Q test and quantified via the I 2 value.
FIGURE 3
FIGURE 3
Meta‐analysis of fluorescence angiography versus the control for postoperative morbidity expressed as difference risk. Forest plot comparing fluorescence angiography versus the control for morbidity (Clavien–Dindo score ≥ 3a). Each horizontal bar summarizes a study. The bars represent 95% confidence intervals. The grey squares indicate each of the studies' weights in the meta‐analysis. The diamond in the lower part of the graph depicts the pooled estimate along with 95% confidence intervals. The odds ratio (OR) was obtained via models with random effects (Mantel–Haenszel). Heterogeneity was assessed via the Q test and quantified via the I 2 value.
See this image and copyright information in PMC

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