Indocyanine green fluorescence–guided perfusion vs. standard assessment to prevent clinical anastomotic leak after colorectal resection: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials with site-specific subgroup

Moderate-certainty evidence demonstrates that ICG fluorescence-guided perfusion assessment reduces clinical anastomotic leaks by approximately 31% after colorectal resection, supporting its adoption to enhance intraoperative decision making and improve patient outcomes, despite no significant impact on other perioperative endpoints. However, the absence of standardized, objective criteria for ICG interpretation, accounting for patient-specific factors such as cardiovascular disease and obesity, remains a critical barrier to achieving reproducible clinical benefits and represents an essential priority for future validation studies.