Lancet Gastroenterology & Hepatology最新文献

{"title":"Early-onset colorectal cancer: rising rates require rising awareness","authors":"The Lancet Gastroenterology & Hepatology","doi":"10.1016/s2468-1253(26)00096-8","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00096-8","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"36 8-12 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147681104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global burden of metabolic dysfunction-associated steatotic liver disease, 1990–2023, and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2023","authors":"","doi":"10.1016/s2468-1253(26)00011-7","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00011-7","url":null,"abstract":"<h3>Background</h3>Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease, is one of the most prevalent liver diseases globally, contributing to both economic and health-related challenges. We aimed to evaluate the global, regional, and national burden of MASLD from 1990 to 2023, quantify the contribution of identified modifiable risk factors, and project future prevalence up to the year 2050.<h3>Methods</h3>Estimates of MASLD prevalence and disability-adjusted life-years (DALYs) were produced by age, sex, region, Socio-demographic Index (SDI), and Healthcare Access and Quality (HAQ) index across 204 countries and territories from 1990 to 2023 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023. The MASLD burden attributable to three risk factors (smoking, high BMI, and high fasting plasma glucose) was assessed as part of the GBD comparative risk assessment. As a secondary analysis, we used these estimates to forecast MASLD prevalence up to 2050 using fasting plasma glucose and mean BMI as predictors. Furthermore, to examine the relative contributions of population ageing, population growth, and changes in MASLD prevalence rate to the forecasted changes in case counts from 2023 to 2050, we conducted a decomposition analysis.<h3>Findings</h3>In 2023, approximately 1·3 billion (95% uncertainty interval [UI] 1·2 to 1·4) individuals were estimated to be living with MASLD (ie, 16·1% of the global population), with an age-standardised prevalence rate of 14 429·3 (95% UI 13 268·3 to 15 990·6) per 100 000 population, representing a percentage increase of 142·7% (95% UI 139·2 to 146·7) in crude numbers from 1990 (0·5 billion [0·5 to 0·6]) and of 28·6% (27·8 to 29·5) in the rate (11 217·2 [10 276·8 to 12 467·0] per 100 000 in 1990). An estimated 3·6 million (2·8 to 4·5) total DALYs were attributable to MASLD worldwide in 2023, corresponding to an age-standardised DALY rate of 39·6 (31·2 to 49·9) per 100 000 population. Despite a 116·3% (93·3 to 139·4) increase in crude DALYs (from 1·7 million [1·3 to 2·1] in 1990), its age-standardised estimate remained consistent (1·8% [–8·6 to 12·8]) from 1990 (38·9 [30·1 to 49·8] per 100 000) to 2023. There was substantial variation in age-standardised estimates across regions. North Africa and the Middle East had the highest prevalence rate (29 246·1 [26 848·3 to 32 048·7] per 100 000) and Andean Latin America showed the highest DALY rate (152·3 [114·1 to 194·7] per 100 000). By contrast, the high-income Asia Pacific region had the lowest prevalence rate (8653·5 [7923·7 to 9592·8] per 100 000) and east Asia had the lowest DALY rate (16·3 [13·5 to 19·9] per 100 000) among all GBD regions. North Africa and the Middle East showed disproportionately higher prevalence rates relative to other regions with similar SDIs. Lower SDIs and HAQs were associated with higher age-standardised DALY rates. The age-standardised prevalence r","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"55 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147666705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shared principles within HBV guidelines: aligning clinical approach with differentiated care for global elimination","authors":"Su Wang, Sabela Lens, You Hong, Norah Terrault, Jessica Hicks, Cary James, Chari Cohen, Saeed Hamid","doi":"10.1016/s2468-1253(26)00050-6","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00050-6","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"5 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147599206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted versus conventional minimally invasive oesophagectomy for oesophageal squamous cell carcinoma (RAMIE): a multicentre, open-label, randomised, phase 3, non-inferiority trial","authors":"Yang Yang, Zhichao Liu, Chunguang Li, Bin Li, Bentong Yu, Jun Yi, Xiaobin Zhang, Hezhong Chen, Hecheng Li, Lijie Tan, Rong Hua, Xufeng Guo, Xinyu Yang, Wenyan Ma, Yifeng Sun, Zhigang Li, Yi He, Hong Zhang, Yuchen Su, Haiyong Gu, Jun Liu, Ming Zhang, Jinchen Shao, Yuchen Han, Jian Tang, Chunlin Ye, Lei Jiang, Hao Peng, Maierhaba Maitiyasen, Yuanpeng He, Bowen Shi, Jiang Hong, Chaojing Lu, Weizheng Zhou, Shengguang Zhao, Liqin Zhao, Xiaoyan Chen, Zenghui Cheng, Yong Fang, Heng Jiao, Han Tang","doi":"10.1016/s2468-1253(25)00402-9","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00402-9","url":null,"abstract":"<h3>Background</h3>Robot-assisted minimally invasive oesophagectomy is used increasingly worldwide. However, no large-scale, multicentre, randomised controlled trial has compared long-term survival as the primary endpoint between robot-assisted oesophagectomy and conventional thoracoscopic oesophagectomy. We aimed to confirm the non-inferiority in overall survival of robot-assisted oesophagectomy over thoracoscopic oesophagectomy in patients with resectable oesophageal squamous cell carcinoma.<h3>Methods</h3>This multicentre, open-label, randomised, controlled, phase 3, non-inferiority trial (RAMIE) was conducted at six hospitals in China. Patients aged 18–75 years, with biopsy-proven squamous cell carcinoma, Eastern Cooperative Oncology Group scores of 0–2, and with tumour and nodal classifications of cT1–4a, N0–2, M0, or M1 (supraclavicular lymph nodes metastasis) were eligible. Patients were randomly assigned (1:1) using a computer-generated randomisation list and stratified by neoadjuvant therapy to robot-assisted oesophagectomy or thoracoscopic oesophagectomy, both with at least two-field lymphadenectomy. The primary endpoint was overall survival, analysed in the intention-to-treat population. The non-inferiority margin was 9% for 5-year overall survival (the upper limit of 95% CI of the hazard ratio [HR] was 1·33). Harms were assessed in the per-protocol population, defined as all eligible participants undergoing resection. This trial was registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, number <span><span>NCT03094351</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span> and is completed.<h3>Findings</h3>Between Aug 2, 2017, and Dec 23, 2019, 362 patients were randomly assigned (183 to robot-assisted oesophagectomy and 179 to thoracoscopic oesophagectomy. 309 (85%) of 362 patients were men and 53 (15%) were women. Two patients in each group did not undergo resection and were excluded from the per-protocol population. Median follow-up of the planned final analysis was 71·5 months (IQR 63·9–81·8). At 5 years, overall survival was 69·4% (95% CI 62·1–75·6) with robot-assisted oesophagectomy versus 56·2% (48·5–63·2) with thoracoscopic oesophagectomy (HR 0·71, 95% CI 0·51–0·97), confirming non-inferiority (one-sided p<sub>non-inferiority</sub>=0·0001; exploratory analysis of p=0·032 for superiority). Intraoperative conversions to open surgery were similar between study groups (seven [4%] of 181 patients in the robot-assisted group <em>vs</em> six [3%] of 177 in the thoracoscopic group). Postoperative grade 3 or higher complications were comparable (22 [12%] of 181 patients in the robot","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"89 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The burden of chronic hepatitis B and C in 2022 and progress towards elimination: a global report.","authors":"Fuqiang Cui,Diana Faini,Devin Razavi-Shearer,Homie Razavi,Casimir Manzengo Mingiedi,Monica Alonso Gonzalez,Ahmed Sabry Alaama,Antons Mozalevskis,Polin Chan,Kiyohiko Izumi,Mohamed Amine Ghrabi,Meg Doherty,Lesi Olufunmilayo,Niklas Luhmann,Catherine de Martel,Mae Dirac,Timothy B Hallett,Shevanthi Nayagam,Peter Vickerman,Daniel Low-Beer","doi":"10.1016/s2468-1253(25)00375-9","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00375-9","url":null,"abstract":"BACKGROUNDWHO has worked closely with member states to set baseline targets, monitor progress and gaps, and develop a strategy to achieve the elimination of viral hepatitis as a public health threat by 2030. This analysis aimed to use the latest data to assess global progress, identify gaps, and provide strategic support to countries and regions to scale up prevention and treatment services to meet global, regional, and country-level targets.METHODSData on key indicators for 2022 were collated in 2023, including prevalence, incidence, mortality, and the cascade of care for chronic hepatitis B virus (HBV) and chronic hepatitis C virus (HCV) infections. WHO country offices, regional offices, related departments, and partners were involved to verify and ensure the quality and completeness of the data. Data from 2022 were compared with historical data to monitor progress, and reported data were compared with expected data and targets to identify gaps in incidence and mortality.FINDINGSAs of June 30, 2023, WHO had received verified data reports from 187 of 194 countries and territories, including data contributions from collaborative partners. We estimated that, in 2022, globally, 254 million (3·27%) of 7758 million people were living with chronic HBV infection and 50 million (0·65%) people were living with HCV infection. Overall, five countries (China [83·7 million; 27·5%], India [35·3 million; 11·6%], Indonesia [18·9 million; 6·2%], Nigeria [15·7 million; 5·2%], and Pakistan [12·6 million; 4·2%]) accounted for 55% of the combined global burden of HBV and HCV. There were more than 2·2 million (95% CI 1·8-2·7) new chronic HBV and HCV infections and more than 1·3 million (95% CI 1·1-1·6) deaths due to HBV and HCV in 2022, with the majority of deaths due to HBV (1·1 million [95% CI 0·98-1·24]); as a result, the point estimate for deaths due to hepatitis in 2022 exceeded that of deaths due to tuberculosis in 2023 (1·25 million [95% UI 1·13-1·37]). There were 1·2 million new chronic HBV infections worldwide in 2022; 62·7% (771 000) of these new infections occurred in the African Region. In 2022, 34·1 million (95% CI 30·2-38·5) individuals living with HBV were diagnosed; of these, 6·6 million (95% CI 5·9-7·5) received antiviral treatment. In 2022, 25·7 million (95% CI 19·5-28·8) individuals were diagnosed with HCV infection and 12·5 million (95% CI 9·5-14·0) were treated with direct-acting antiviral drugs in 2015-22.INTERPRETATIONViral hepatitis represents a substantial burden of infectious disease globally, comparable with that caused by tuberculosis. Progress towards global hepatitis elimination is currently insufficient to meet the 2030 targets defined in the UN Sustainable Development Goals; efforts need to be rapidly and urgently scaled up across all regions. In particular, given the rising mortality due to hepatitis B globally, expansion of hepatitis B vaccination is a priority, particularly in the African Region, where the majority of new chronic HB","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"52 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147524658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transanal total mesorectal excision in the era of robotic surgery","authors":"Patricia Sylla","doi":"10.1016/s2468-1253(26)00075-0","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00075-0","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"14 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term progression of steatotic liver disease: multiple drivers of the same disease?","authors":"Helena Cortez-Pinto","doi":"10.1016/s2468-1253(26)00086-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00086-5","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"57 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transanal total mesorectal excision versus laparoscopic total mesorectal excision for mid and low rectal cancer (COLOR III): short-term outcomes of an international, multicentre, phase 3, randomised, controlled, non-inferiority trial","authors":"Jurriaan B Tuynman, Hongwei Yao, Laura R Moolenaar, Colin Sietses, Roel Hompes, Felix Aigner, Antonio Caycedo–Marulanda, Chien-Chih Chen, Muneer Deeb, Pascal G Doornebosch, Bo Feng, Chi-Chung Foo, Alois Fürst, Masaaki Ito, Francisco B de Lacy, Pedro Leão, Justin A Maykel, Andrea Muratore, Stefan E van Oostendorp, Sung Chan Park, Michał Pędziwiatr, MingYang Ren, Gerald Seitinger, Hein B A C Stockmann, Aaldert K Talsma, Andreas Türler, Weidong Tong, Quan Wang, Qing Xu, Hongyu Zhang, Jan-Hein T M van Waesberghe, Mahsoem Ali, Jos W R Twisk, Zhongtao Zhang, Antonio M de Lacy, George B Hanna, Hendrik J Bonjer, Muneer Deeb, Mahsoem Ali, Jaap Bonjer, Charlotte Deijen, Roel Hompes, Thomas Koedam, Wytze Lameris, Annabel van Lieshout, Linda Mol, Laura Moolenaar, Stefan van Oostendorp, Jurriaan Tuynman, Jos Twisk, Jan-Hein van Waesberghe, Bin Huang, Feifei Huang, Zhigang Ke, Fan Li, Xiaoli Ran, Yue Tian, Weidong Tong, Li Wang, Xiangfeng Wang, Guodong Xiao, Liyang Yao, Jingwang Ye, Huichao Zheng, Yongbo An, Jiale Gao, Jianning Song, Pengyu Wei, Guocong Wu, Zhengyang Yang, Hongwei Yao, Zhongtao Zhang, Pedro Leão, Maria Sousa, Marion Brunner, Arthur Heiligensetzer, Peter Sauer, Alois Fürst, Vinzenz Völkel, Matthias Biebl, Luca Dittrich, Rosa Schmuck, Robbert Bosker, Koen Talsma, Andrea Muratore, Patrizia Marsanic, Gabie de Jong, Guusje Vughs, Colin Sietses, Antonio Caycedo-Marulanda, Sanjiv Mathur, Pamela Leduc, Raquel Bravo, Marlene Caldera, Yoelimar Guzmán, Francisco Borja de Lacy, Antonio María de Lacy, Ana Otero, Miguel Pera, Pascal Doornebosch, Maarten Vermaas, Michal Pędziwiatr, Andreas Türler, Haug-Lambert Loriz, Chien-Chih Chen, Chun-Ho Chu, Felix Aigner, Gabriele Moitzi, Richard Stadler, Gerald Seitinger, Qing Guo, MingYang Ren, Qing Teng, Dongbing Zhou, Sung Chan Park, Masaaki Ito, Hiro Hasegawa, Chi Chung Foo, Abraham Man, Lei Gu, Qing Xu, Batuer Aikemu, Bo Feng, Zhenghao Cai, Haiqin Song, Minhua Zheng, Ronald Vuylsteke, Hein Stockmann, Hou-Hsuan Cheng, Jeng-Kai Jiang, Chung-Chi Lin, Hung-Hsin Lin, Yinggang Ge, Xingye Wu, Xiang Xu, Hongyu Zhang, Liang He, Yuchen Guo, Yang Gong, Quan Wang, Karim Alavi, Justin Maykel, Paul Sturrock, Jingjing He","doi":"10.1016/s2468-1253(26)00022-1","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00022-1","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"1 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Binge drinking, metabolic dysfunction, and the spectrum of steatotic liver disease in the USA: a cross-sectional and longitudinal analysis","authors":"Zobair M Younossi, Aleksander Krag, Shira Zelber-Sagi, Markos Kalligeros, Marco Arrese, Luis Antonio Diaz, Juan Pablo Arab, Ashwani K Singal, Mario G Pessoa, Robert J Wong, Javier Crespo, Maja Thiele, Ajay Duseja, C Wendy Spearman, Mohamed El-Kassas, Yusuf Yilmaz, Jiangao Fan, Laurent Castera, Frank Tacke, Vincent Wai-Sun Wong, Michael Betel, Andrei Racila, Ariana Nader, Gabriella Y Paik, Dana Ivancovsky Wajcman, Laura Sol Grinshpan, Linda Henry, Yuchiro Eguichi, Janus P Ong, Fatema Nader, Saleh A Alqahtani, James M Paik","doi":"10.1016/s2468-1253(25)00376-0","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00376-0","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"14 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indocyanine green fluorescence angiography for anastomotic perfusion assessment in colorectal surgery: a systematic review with meta-analysis, meta-regression, and trial sequential analyses","authors":"Éanna J Ryan, Odhrán K Ryan, Neil Corrigan, Gemma Ainsworth, Denise E Hilling, Alexander L Vahrmeijer, Jyrki Kössi, Jun Watanabe, David Jayne, Ronan A Cahill","doi":"10.1016/s2468-1253(25)00373-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00373-5","url":null,"abstract":"<h3>Background</h3>Anastomotic leak is a serious complication in colorectal surgery. Indocyanine green fluorescence angiography (ICGFA) is an adjunctive digital method of assessing bowel perfusion intraoperatively. We assessed whether ICGFA use during surgery reduces postoperative anastomotic leak exclusively using data from randomised controlled trials (RCTs).<h3>Methods</h3>In this systematic review and meta-analysis, we searched PubMed, ScienceDirect, Scopus, Web of Science, Embase, and the Cochrane Collaboration databases from inception to July 19, 2025, for English-language RCTs comparing additive intraoperative ICGFA with standard surgeon perfusion assessment alone in patients undergoing colorectal resection with primary anastomosis according to prespecified criteria and PRISMA guidelines. Summary-level data were extracted by two reviewers. The primary outcome was overall anastomotic leak rate. The Jadad scale (Oxford quality scoring system) was used to assess trial quality, the Cochrane Risk of Bias (RoB 2) tool for RCTs was used to assess risk of bias, and GRADE was used to assess strength of evidence. Meta-regression and trial sequential analyses were performed. This study is registered with PROSPERO, CRD420250652639.<h3>Findings</h3>719 records were initially identified, with 387 remaining after screening and 184 sought for full eligibility screening, of which nine were eligible RCTs (with 4754 patients) for analysis. ICGFA significantly reduced overall anastomotic leak (risk ratio 0·66 [95% CI 0·56–0·78], p<0·0001; number needed to treat [NNT]=24), with trial sequential analysis showing that the required information size (2183) was exceeded overall. ICGFA reduced both anastomotic leak requiring intervention (risk ratio 0·73 [95% CI 0·60–0·89], p=0·0020; NNT=39) and anastomotic leak not requiring intervention (0·48 [0·31–0·72], p=0·0004, NNT=35). Significant benefit was observed for left-sided resections (risk ratio 0·62 [95% CI 0·51–0·74], p<0·0001; NNT=19), rectal resections (0·62 [0·51–0·76], p<0·0001; NNT=19), and low anterior resections (0·62 [0·48–0·79], p<0·0001; NNT=13), in which the required information size was also exceeded, but not for right-sided resections. In the meta-regression analysis, among all tested covariates, only patient BMI significantly modified the ICGFA treatment effect, with an increasing protective effect with increasing BMI (coefficient –0·0153 [95% CI –0·0251 to –0·0056], p=0·0020). Evidence was graded as high certainty for overall, left-sided, rectal, asymptomatic, and 30-day anastomotic leaks, and moderate certainty for clinically significant anastomotic leak.<h3>Interpretation</h3>Intraoperative use of ICGFA reduces anastomotic leak rates in left-sided and rectal colorectal resections. Given the evidence available now, further general efficacy trials are no longer required and research should shift to implementation and defined targeted subgroup ICGFA role definition (ie, in non-rectal left","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"22 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147495304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}