indocyanine green dye fluorescence imaging and colorectal cancer anastomotic leak rate: a narrative review

Anastomotic leak is a significant morbidity in colorectal surgeries. the risk factors for anastomotic leakage are multifactorial with vascularity of the bowel edge playing an important role. icg (indocyanine green) dye emits fluorescence and this principle is used to assess the bowel edge vascularity before anastomosis. the context of the study is that even though icg dye is being utilized in colorectal cancer surgery for quite a while the evidence is not strong. most of the data on the role of icg dye in decreasing the anastomotic leak rate in colorectal cancer surgery comes from retrospective and few prospective trials. there are a few recently published randomized controlled trials (rct) with contrasting outcomes in this regard. pubmed, embase and scopus databases were searched with the keywords indocyanine green and colorectal surgery and anastomotic leak for rcts published till 31st december 2023. of the total number of search results, four completed rcts were found and were included in this review. the results of the rcts are discussed with a critical eye in the text. this narrative review is an attempt to understand the outcomes of the published rcts with reviewing the variables of the study population of these studies and their applicability in real world clinical scenarios. to conclude, the role of icg dye is not well established in reducing anastomotic leak rates following colorectal anastomosis, but there is growing evidence to support its use.