Comparative perioperative outcomes of intravenous indocyanine green during robot-assisted cystectomy: a meta-analysis and systematic review.

Abstract

This study aimed to evaluate the clinical utility of intravenous indocyanine green (ICG) in the context of robot-assisted cystectomy (RAC) through a systematic review and meta-analysis. The primary focus was to compare postoperative complications and perioperative outcomes between the ICG cohort and the non-ICG cohort. The primary outcome indicators were the incidence of ureteroenteric strictures and the number of strictures anastomoses. A comprehensive search was performed across multiple databases, including PubMed, Embase, the Cochrane Library, and Web of Science, to identify pertinent studies that evaluate the application of ICG in RAC. The analysis of dichotomous variables was performed using relative risk (RR), while weighted mean difference (WMD) was utilized for comprehensive assessment of continuous variables. A total of 4 studies encompassing 732 patients were included in the analysis, comprising 311 patients who received ICG and 421 patients who did not. The baseline characteristics were found to be comparable between the two cohorts. The meta-analysis indicated that the occurrence of 90-day severe complications was markedly lower in the ICG cohort versus the non-ICG cohort (RR = 0.63, 95% CI 0.44-0.90, P = 0.011). In addition, the length of ureteral resection was longer in the ICG cohort compared to the non-ICG cohort (WMD = 0.25, 95% CI 0.01-0.49, P = 0.039), with notably significant results for right-side procedures (WMD = 0.54, 95% CI 0.28-0.80, P < 0.001). Nevertheless, no substantial differences observed between the two cohorts regarding the occurrence of ureteroenteric stricture, numbers of strictures at anastomoses, operative time (OT), length of hospitalization (LOS), or lymph node positivity. Compared with the non-ICG cohort, the ICG cohort had comparable efficacy and was able to reduce the incidence of 90-day severe complications. The use of intravenous ICG showed promising clinical applicability during RAC; however, additional long-term studies are necessary to substantiate its effectiveness.