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.
背景：荧光剂与成像系统的应用是结直肠癌外科治疗中一种极具前景的辅助手段。本系统综述与荟萃分析旨在评估荧光引导手术在结直肠癌治疗中的安全性与有效性，并与传统（非荧光引导）手术进行对比。方法：通过检索MEDLINE、Embase、Emcare及CINAHL数据库，收集2000年1月至2024年1月期间报道结直肠癌荧光引导手术结局数据的研究（含或不含传统手术对照组）。采用随机效应模型进行荟萃分析，并评估研究间异质性。结果：共纳入35项研究，涉及3217例结直肠癌患者：其中26项研究（964例患者）报告荧光引导手术数据，9项研究（2253例患者）对比荧光引导与传统手术。荧光引导手术的加权平均肿瘤检出率为71%（95% CI 0.55–0.85），荧光组与传统手术组的淋巴结检出率无显著差异（WMD −0.04；95% CI −0.10–0.02；p=0.201）。荧光引导手术组的术中失血量（WMD −4.38；95% CI −7.05–−1.70；p=0.001）与并发症发生率（WMD −0.04；95% CI −0.07–0.00；p=0.027）显著更低，且吻合口漏发生率可能更低（WMD −0.05；95% CI −0.10–0.01；p=0.092）。结论：荧光引导手术是结直肠癌治疗中安全有效的方法，可能减少术中失血及并发症。未来需开展更多随机对照试验，比较荧光引导手术与传统手术，以明确其预后获益及在结直肠癌治疗路径中的精准定位。
肿瘤(癌症)患者之家