Background: LAR for rectal cancer requires optimal bowel perfusion to minimize AL, a serious postoperative complication. Preservation of the left colic artery (LCA) through skeletonization may improve vascular supply. Indocyanine green (ICG) fluorescence imaging is increasingly utilized intraoperatively to assess real-time bowel perfusion and guide surgical decisions. Methods: A systematic review was conducted following PRISMA guidelines. Databases including PubMed, Scopus, Web of Science, and Embase were searched up to May 2025. Studies evaluating intraoperative ICG fluorescence imaging in colorectal cancer surgery with outcomes related to AL, lymph node yield, or recurrence were included. Both randomized and observational studies were considered. Quality was assessed using the Newcastle-Ottawa Scale, and a qualitative synthesis was performed. Results: Nine studies involving 1771 patients met inclusion criteria. ICG fluorescence imaging consistently improved intraoperative assessment of bowel perfusion, influencing surgical decision-making and reducing AL rates, particularly when combined with LCA skeletonization. Preservation of the LCA was associated with enhanced vascular integrity and comparable lymph node yields. Studies reported an AL reduction from approximately 10% to below 5% with ICG guidance. ICG also aided in optimizing transection lines and improved lymphadenectomy precision. Conclusion: ICG fluorescence imaging, combined with LCA skeletonization, appears to enhance bowel perfusion assessment and reduce anastomotic complications in LAR for colorectal cancer. While promising, further randomized controlled trials are needed to confirm long-term oncologic outcomes and establish standardized protocols.
Rashid et al. (2026) studied this question.