Indocyanine green fluorescence angiography enhances surgical planning in laparoscopic low anterior resection for rectal cancer, leading to better patient outcomes.

• Patients with perfusion risks (older age, higher BMI, neoadjuvant therapy) benefited from ICG-guided plan changes, resulting in significantly higher anastomoses (8.0 cm vs. 6.0 cm, p < 0.001).
• This group reported superior bowel function with lower LARS scores (18 vs. 25, p = 0.007) and fewer major complications (14.3% vs. 32.1%, p = 0.041).

Routine use of ICG can personalize surgical approaches for better functional recovery in these patients.