Efficacy and Safety of Fluorescence-Guided Surgery Compared to Conventional Surgery in the Management of Colorectal Cancer: A Systematic Review and Meta-Analysis
by
, , ,
Michael G. Fadel
1,2,*,
Elham Zonoobi
3,4, 
María Rita Rodríguez-Luna
5,
Kohei Mishima
6,
Frédéric Ris
7,8,
Michele Diana
7,8,9,
Alexander L. Vahrmeijer
4,
Silvana Perretta
6,10,11,
Hutan Ashrafian
1 and
Matyas Fehervari
1,12 1
Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
2
Department of General Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK
3
Edinburgh Molecular Imaging Limited, Nine Edinburgh Bioquarter, Edinburgh EH16 4UX, UK
4
Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
5
Department of General Surgery, Hospital de Barcelona, 08001 Barcelona, Spain
6
Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France
7
Department of Surgery, University Hospital of Geneva, 1205 Geneva, Switzerland
8
Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
9
ICube Laboratory, Photonics Instrumentation for Health, 67034 Strasbourg, France
10
IHU-Strasbourg, Institute of Image-Guided Surgery, 67000 Strasbourg, France
11
Department of Digestive and Endocrine Surgery, University of Strasbourg, 67081 Strasbourg, France
12
Department of Gastrointestinal Surgery, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells TN2 4QJ, UK
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(19), 3377; https://doi.org/10.3390/cancers16193377
Submission received: 31 July 2024
/
Revised: 9 September 2024
/
Accepted: 24 September 2024
/
Published: 2 October 2024
(This article belongs to the Section Systematic Review or Meta-Analysis in Cancer Research)
Simple Summary
Colorectal cancer is the second highest cause of cancer mortality globally. Surgery is often performed to remove the cancer and improve survival. Special dyes, called fluorescent agents, can help surgeons identify the tumour tissue and guide them during the operation to precisely remove the cancer, thereby improving patient outcomes. The exact benefit of fluorescence-guided surgery in the management of colorectal cancer is not clearly established, necessitating this systematic review and meta-analysis of the literature to assess the safety and efficacy of this surgery. A total of 35 studies of 3217 patients were included in this analysis. This showed that fluorescence-guided surgery is a safe and effective approach, potentially reducing intraoperative blood loss and postoperative complication rates, when compared to surgery without the use of fluorescence agents. Further prospective clinical trials are required to establish the long-term oncological benefit of fluorescence-guided surgery.
Abstract
Background: The use of fluorescence agents and imaging systems is a promising adjunct in the surgical management of colorectal cancer. This systematic review and meta-analysis aimed to assess the safety and efficacy of fluorescence-guided surgery in the management of colorectal cancer, with a comparison to conventional (non-fluorescence-guided) surgery. Methods: A literature search of MEDLINE, Embase, Emcare, and CINAHL databases was performed for studies that reported data on the outcomes of fluorescence-guided surgery, with or without a comparison group undergoing conventional surgery, for colorectal cancer between January 2000 and January 2024. A meta-analysis was performed using random-effect models, and between-study heterogeneity was assessed. Results: 35 studies of 3217 patients with colorectal cancer were included: 26 studies (964 patients) reported on fluorescence-guided surgery and 9 studies (2253 patients) reported on fluorescence versus conventional surgery. The weighted mean of the cancer detection rate of fluorescence-guided surgery was 71% (95% CI 0.55–0.85), with no significant difference in lymph node yield ratio (WMD −0.04; 95% CI −0.10–0.02; p = 0.201) between fluorescence and conventional surgery groups. There was a significantly lower blood loss (WMD −4.38; 95% CI −7.05–−1.70; p = 0.001) and complication rate (WMD −0.04; 95% CI −0.07–0.00; p = 0.027) in the fluorescence-guided surgery group, with a potentially lower anastomotic leak rate (WMD −0.05; 95% CI −0.10–0.01; p = 0.092). Conclusions: Fluorescence-guided surgery is a safe and effective approach in the management of colorectal cancer, potentially reducing blood loss and complications. Further randomised controlled trials are required comparing fluorescence-guided surgery with conventional surgery to determine its prognostic benefit and where it should precisely fit within the management pathway of colorectal cancer.
