Tattooing or not? A review of current practice and outcomes for laparoscopic colonic resection following endoscopy at a tertiary care centre

Abstract

Background: Because small colonic tumours may not be visualized or palpated during laparoscopy, location of the lesion must be identified before surgery. The aim of this study was to evaluate the effectiveness of the current recommendation of endoscopic tattooing of lesions prior to laparoscopic colonic resections.Methods: All consecutive patients who underwent elective laparoscopic resection for a colonic lesion at a single tertiary institution between 2013 and 2015 were identified for chart review. Results:In total, 224 patients underwent laparoscopic resection for a benign or malignant colonic lesion during the study period. All patients had a complete colon oscopy preoperatively. In all, 148 patients (66%) had their lesion tattooed at endos copy. Most lesions were tattooed distally, but 15% were tattooed either proximally, both proximally and distally, or tattooed without specifying location as proximal or distal. Tattoo localization was accurate in 69% of cases. Tattooed lesions were not visible during surgery 21.5% of time; 2 cases were converted to open surgery to identify the lesion. Inaccuracy in endoscopic localization led to change in surgical plan in 16% of surgeries. In the nontattooed group, 1 case was converted to open surgery to localize the lesion, 3 required intraoperative colonoscopy and 1 had posi tive margins on final pathology. Conclusion:To improve surgical planning, we recommend the practice of endo scopic tattooing of all colon lesions at a location just distal to the lesion using multiple injections to cover the circumference of the bowel wall.Contexte : Comme il n'est pas toujours possible de voir ou de palper les petites tumeurs du côlon durant la laparoscopie, le siège de la lésion doit être localisé avant la chirurgie. Le but de cette étude était d'évaluer l'efficacité de la recommandation actuelle, qui consiste à tatouer les lésions au cours de l'endoscopie, avant les colec tomies laparoscopiques.Méthodes : Nous avons recensé tous les patients consécutifs ayant subi une résection laparoscopique non urgente d'une lésion du côlon dans un même établissement de soins tertiaires entre 2013 et 2015 afin d'analyser leurs dossiers.Résultats : En tout, 224 patients ont subi la résection laparoscopique d'une lésion bénigne ou maligne du côlon durant la période visée. Tous les patients ont passé une coloscopie totale avant la chirurgie. Le tatouage endoscopique de la lésion a été effec tué pour 148 patients (66 %). La plupart des lésions ont été tatouées au point distal, mais 15 % l'ont été soit au point proximal, soit au point proximal et au point distal, soit sans précision quant à l'emplacement. La localisation par tatouage était exacte dans 69 % des cas. Les lésions tatouées n'étaient pas visibles durant la chirurgie dans 21,5 % des cas; 2 cas ont été convertis en chirurgies effractives afin qu'on puisse repérer la lésion. L'inexactitude de la localisation endoscopique a entraîné la modification du plan chirurgical dans 16 % des chirurgies. Dans le groupe non tatoué, 1 cas a été converti ...

Endoscopic tattooing for colorectal lesions: impact on quality of care and patient outcomes

“…18 The safety and efficacy of endoscopic tattooing have been reported in many studies, but its routine use has still not been achieved. 4,5,8,15 The lack of endoscopic tattooing may result in significant difficulty in identifying the lesion of interest and may ultimately result in inadequate oncological clearances, perioperative difficulties and an increase in the rate of conversion of open surgeries. 4,5 In spite of such concerns, the real incidence of not tattooing by the endoscopist when lesions suspicious for malignancy are identified remains unclear.…”

“…In conclusion, all colonic lesions that appear to be malignant should be tattooed during endoscopy to improve surgical localisation. 5,16,19 Tattoo endoscopy is a safe and effective method for preoperative tumour localisation. [4][5][6][7][8]11 A need for improvement and uniformity of tattoo practice among endoscopists despite the National Bowel Cancer Screening Programme guidelines is important.…”

“…Identification of these early lesions is challenging, even during open surgery, in the absence of any markers. 4,5 The preoperative marking of colorectal lesions also assists to ensure adequate margins for resection.…”

“…Endoscopic tattooing is a reliable method of localisation and has been widely practised. [4][5][6][7][8] The aim of the study was to assess adherence to the tattoo protocol published by the British Society of Gastroenterologist in our endoscopy unit. 9…”

Accuracy of CT colonography in the preoperative staging of colon cancer: a prospective study of 217 patients

“…Colonoscopy failed to locate the tumour in four (21%) cases and located the tumour incorrectly at least 6.5% of cases in other series , which is similar to our series. Tattooing cannot be seen in laparoscopic surgery in at least 12–21% of cases . Therefore, CTC is a good solution in all these circumstances.…”