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Nawras M, Chawla K, DeRiso A, Dubchuk C, Beran A, Aziz M, Pannell SM. The effect of preoperative endoscopic tattooing on lymph node retrieval in colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2023; 38:166. [PMID: 37294461 DOI: 10.1007/s00384-023-04466-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE The effect of preoperative endoscopic tattooing (ET) on accurate colorectal cancer localization and resection has been well established. However, its effect on lymph node (LN) retrieval remains unclear. The purpose of this study was to systematically compare LN retrieval between patients with colorectal cancer who underwent preoperative ET and those who did not. METHODS A systematic search for relevant studies was conducted using the following databases: PubMed, Embase, and Web of Science. Studies that compared LN retrieval in patients with colorectal cancer with and without preoperative ET were included. Weighted pooled odds ratio (OR) and mean difference (MD) with the corresponding 95% confidence intervals (CIs) for all outcomes using the random-effects model were calculated. RESULTS 10 studies, including 2231 patients with colorectal cancer were included. Six studies reported total LN yield and showed significantly higher LN yield in the tattooed group (MD:2.61; 95% CI:1.01-4.21, P=0.001). Seven studies reported the number of patients with adequate LN retrieval and showed a significantly higher number of patients with adequate LN retrieval in the tattooed group (OR:1.89, 95% CI:1.08-3.32, P=0.03). However, subgroup analysis revealed that both outcomes were only statistically significant in patients with rectal cancer, and not in patients with colon cancer. CONCLUSIONS Our results suggest that preoperative ET is associated with increased LN retrieval in patients with rectal cancer, but not in colon cancer. Further large-scale randomized control trials are necessary to validate our findings.
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Affiliation(s)
- Mohamad Nawras
- College of Medicine and Life Sciences, University of Toledo, 3000 Arlington Ave, Toledo, OH, 43614, USA.
| | - Karan Chawla
- College of Medicine and Life Sciences, University of Toledo, 3000 Arlington Ave, Toledo, OH, 43614, USA
| | - Armelle DeRiso
- Department of Surgery, University of Toledo, Toledo, OH, USA
| | | | - Azizullah Beran
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Muhammad Aziz
- Department of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | - Stephanie M Pannell
- College of Medicine and Life Sciences, University of Toledo, 3000 Arlington Ave, Toledo, OH, 43614, USA
- Department of Surgery, University of Toledo, Toledo, OH, USA
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Oral Antibiotics Bowel Preparation Without Mechanical Preparation for Minimally Invasive Colorectal Surgeries: Current Practice and Future Prospects. Dis Colon Rectum 2022; 65:e897-e906. [PMID: 34856586 DOI: 10.1097/dcr.0000000000002096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The efficacy of preoperative oral antibiotics alone compared with mechanical and oral antibiotic bowel preparation in minimally invasive surgery is still a matter of debate. OBJECTIVE This study aimed to assess the trend of surgical site infection rates in parallel to the utilization of bowel preparation modality over time for minimally invasive colorectal surgeries in the United States. DESIGN This study is a retrospective analysis. SETTINGS The American College of Surgeons National Surgical Quality Improvement Program database was the source of data for this study. PATIENTS Adult patients who underwent elective colorectal surgery and reported bowel preparation modality were included. MAIN OUTCOME MEASURES The primary outcomes measured were the trends and the comparison of surgical site infection rates for mutually exclusive groups according to the underlying disease (colorectal cancer, IBD, and diverticular disease) who underwent bowel preparation using oral antibiotics or combined mechanical and oral antibiotic bowel preparation. Patients who underwent rectal surgery were analyzed separately. RESULTS A total of 30,939 patients were included. Of them, 12,417 (40%) had rectal resections. Over the 7-year study period, mechanical and oral antibiotic bowel preparation utilization increased from 29.3% in 2012 to 64.0% in 2018; p < 0.0001 at the expense of no preparation and mechanical bowel preparation alone. Similarly, oral antibiotics utilization increased from 2.3% in 2012 to 5.5% in 2018; p < 0.0001. For patients with colon cancer, patients who had oral antibiotics alone had higher superficial surgical site infection rates than patients who had combined mechanical and oral antibiotic bowel preparation (1.9% vs 1.1%; p = 0.043). Superficial, deep, and organ space surgical site infection rates were similar for all other comparative colon surgery groups (cancer, IBD, and diverticular disease). Patients with rectal cancer who had oral antibiotics had higher rates of deep surgical site infection (0.9% vs 0.1%; p = 0.004). However, superficial, deep, and organ space surgical site infection rates were similar for all other comparative rectal surgery groups. LIMITATIONS This study was limited by the retrospective nature of the analysis. CONCLUSION This study revealed widespread adoption of mechanical and oral antibiotic bowel preparation and increased adoption of oral antibiotics over the study period. Surgical site infection rates are similar from a clinical relevance standpoint among most comparative groups, questioning the systematic preoperative addition of mechanical bowel preparation to oral antibiotics alone in all patients for minimally invasive colorectal surgery. See Video Abstract at http://links.lww.com/DCR/B828 . PREPARACIN INTESTINAL CON ANTIBITICOS ORALES SIN PREPARACIN MECNICA EN CIRUGAS COLORRECTALES MNIMAMENTE INVASIVAS PRCTICA ACTUAL Y PERSPECTIVAS FUTURAS ANTECEDENTES:La eficacia de los antibióticos orales preoperatorios solos en comparación con la preparación intestinal mecánica mas antibióticos orales en la cirugía mínimamente invasiva es un tema de debate que todavía esta en curso.OBJETIVO:Este estudio tuvo como objetivo evaluar la tendencia de las tasas de infección del sitio quirúrgico en relacion a la utilización de la modalidad de preparación intestinal a lo largo del tiempo en cirugías colorrectales mínimamente invasivas en los Estados Unidos.DISEÑO:Análisis retrospectivo.ENTORNO CLINICO:Base de datos del Programa Nacional de Mejoramiento de la Calidad Quirúrgica del Colegio Estadounidense de Cirujanos.PACIENTES:Pacientes adultos sometidos a cirugía colorrectal electiva y reportados con modalidad de preparación intestinal.PRINCIPALES MEDIDAS DE VALORACIÓN:Tendencias y comparacion de las tasas de infección del sitio quirúrgico para grupos mutuamente excluyentes según la enfermedad subyacente (cáncer colorrectal, enfermedad inflamatoria intestinal y enfermedad diverticular) que se sometieron a preparación intestinal usando antibióticos orales exclusivamente o preparación intestinal mecánica combinada con antibióticos orales. Los pacientes que se sometieron a cirugía rectal se analizaron por separado.RESULTADOS:Se incluyeron un total de 30.939 pacientes. De ellos, 12.417 (40%) se sometieron a resecciones rectales. Durante el período de estudio de siete años, la preparación mecánica del intestino y la utilización de antibióticos orales aumentó del 29,3% en 2012 al 64,0% en 2018; p < 0,0001 sobre la no preparación y de la preparación intestinal mecánica exclusivamente. De manera similar, la utilización de antibióticos orales ha aumentado del 2,3% en 2012 al 5,5% en 2018; p < 0,0001. Para los pacientes con cáncer de colon, los pacientes que recibieron antibióticos orales solos tuvieron mayores tasas de infección superficial del sitio quirúrgico en comparación con los pacientes que recibieron una preparación intestinal mecánica combinada con antibióticos orales (1,9% frente a 1,1%; p = 0,043). Las tasas de infección superficial, profundo del sitio quirúrgico y de los compartimientos intraabdominales fueron similares para todos los demás grupos de cirugía de colon (cáncer, enfermedad inflamatoria intestinal y enfermedad diverticular). Los pacientes con cáncer de recto que recibieron antibióticos orales tuvieron tasas más altas de infección profunda del sitio quirúrgico (0,9% frente a 0,1%; p = 0,004). Sin embargo, las tasas de infección del sitio quirúrgico superficial, profundo y de los compartimientos intraabdominales fueron similares comparativamente para todos los demás grupos de cirugía rectal.LIMITACIONES:Carácter retrospectivo del análisis.CONCLUSIONES:Este estudio reveló la adopción generalizada de preparación intestinal mecánica y antibióticos orales y una mayor aceptación de antibióticos orales durante el período de estudio. Las tasas de infección del sitio quirúrgico parecen ser similares desde un punto de vista de relevancia clínica entre la mayoría de los grupos comparados, lo que cuestiona la adición preoperatoria sistemática de preparación intestinal mecánica a antibióticos orales solos en todos los pacientes para cirugía colorrectal mínimamente invasiva. Consulte Video Resumen en http://links.lww.com/DCR/B828 . (Traducción- Dr. Ingrid Melo ).
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Zhang S, Wang Q, Feng Y, Zhang G, Chen Y, Zheng W, Wu X, Yang A. Clip or Tattooing: A Comparative Study for Preoperative Colon Cancer Endoscopic Localization. Front Oncol 2022; 12:846900. [PMID: 35280761 PMCID: PMC8916562 DOI: 10.3389/fonc.2022.846900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Aim Preoperative endoscopic markers have been extensively used for the localization of colonic neoplastic lesions in laparoscopic surgery. We conducted this respective cohort study to compare the localization accuracy of two commonly used endoscopic marker strategies (endoscopic clip plus abdominal plain film and endoscopic tattooing). Methods Patients who received preoperative colonoscopy localization for colonic neoplasia and underwent an elective laparoscopic operation afterward between 2013 and 2020 were included in this retrospective study. The localization accuracy of the two endoscopic strategies was compared, and the predictors of successful endoscopic localization were identified by multivariate regression. Results In total, 195 patients [average age 62.4 ± 9.2 years, 123 male (63.1%)] undergoing preoperative colonoscopy localization and subsequent laparoscopic colectomy for colonic neoplasms were included. Endoscopic localization was finally proven to be successful in 150 (76.9%) patients in the surgery. Compared to the tattooing group, patients who had successful localization for colonic lesions were fewer in the clip group (64 of 101 cases, 63.4% vs. 86 of 94 cases, 91.5%, p < 0.001). The multivariate regression analysis showed that the endoscopic tattooing strategy, endoscopic clip strategy, and lesion location were all predictors for successful localization (all with p < 0.001). Conclusion Compared with endoscopic clip plus abdominal plain film, endoscopic tattooing had higher localization accuracy and less intraoperative colonoscopy counseling; the endoscopic clip strategy, tattooing strategy, and colonic lesion location were all predictors of successful endoscopic localization.
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Affiliation(s)
- Shengyu Zhang
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Qiang Wang
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Yunlu Feng
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Guannan Zhang
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Yang Chen
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Weiyang Zheng
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Xi Wu
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Aiming Yang
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
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Symer M, Connolly J, Yeo H. Management of the Malignant Colorectal Polyp. Curr Probl Surg 2022; 59:101124. [DOI: 10.1016/j.cpsurg.2022.101124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lin N, Qiu J, Song J, Yu C, Fang Y, Wu W, Yang W, Wang Y. Application of nano-carbon and titanium clip combined labeling in robot-assisted laparoscopic transverse colon cancer surgery. BMC Surg 2021; 21:257. [PMID: 34030673 PMCID: PMC8142471 DOI: 10.1186/s12893-021-01248-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 05/13/2021] [Indexed: 12/15/2022] Open
Abstract
Background Robot-assisted laparoscopic transverse colon tumor surgery requires precise tumor localization. The purpose of this study was to evaluate the safety and efficacy of nano-carbon and titanium clip combination labeling methods in robot-assisted transverse colon tumor surgery. Methods From January 2018 to January 2019, the clinical data of 16 patients who come from FuZhou, China underwent preoperative nano-carbon and titanium clip combined with robot-assisted laparoscopic transverse colon cancer surgery were retrospectively analyzed. Results Of the 16 patients, no signs of abdominal pain, fever, or diarrhea were observed after colonoscopy. Two titanium clips were seen on all of the 16 patients' abdominal plain films. Nano-carbon staining sites were observed during the operation, and no staining disappeared or abdominal cavity contamination. All patients underwent R0 resection. The average number of lymph nodes harvsted was 18.23 ± 5.04 (range, 9–32). The average time to locate the lesion under the laparoscopic was 3.03 ± 1.26 min (range, 1–6 min), and the average operation time was 321.43 ± 49.23 min (range, 240–400 min). All were consistent with the surgical plan, and there was no intraoperative change of surgical procedure or conversion to open surgery. Conclusion Preoperative colonoscopy combined with nano-carbon and titanium clip is safe and effective in robot-assisted transverse colon cancer surgery. A At the same time, the labeling method shows potential in shortening the operation time, ensuring sufficient safety margin and reducing complications.
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Affiliation(s)
- Nan Lin
- Department of General Surgery, 900 Hospital of the Joint Logistics Team, Fuzhou, China
| | - Jiandong Qiu
- Department of Oncological Surgery, Sanming First Hospital Affiliated to Fujian Medical University, Fuzhou, China
| | - Junchuan Song
- Department of General Surgery, Dongfang Hospital, Xiamen University, Xiamen, China
| | - Changwei Yu
- Clinical Institute of Fuzhou General Hospital, Fujian Medical University, Fuzhou, China
| | - Yongchao Fang
- Department of General Surgery, Dongfang Hospital, Xiamen University, Xiamen, China
| | - Weihang Wu
- Department of General Surgery, 900 Hospital of the Joint Logistics Team, Fuzhou, China
| | - Weijin Yang
- Department of General Surgery, 900 Hospital of the Joint Logistics Team, Fuzhou, China
| | - Yu Wang
- Department of General Surgery, 900 Hospital of the Joint Logistics Team, Fuzhou, China.
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Pedersen R, Chen J, Kho KA. Peritoneal and Intestinal Ink Stains from Endoscopic Tattooing Encountered during Gynecologic Surgery. J Minim Invasive Gynecol 2021; 28:1669-1670. [PMID: 34010695 DOI: 10.1016/j.jmig.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Rebecca Pedersen
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas (all authors)
| | - Joseph Chen
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas (all authors)
| | - Kimberly A Kho
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas (all authors)..
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Liu P, Tan J, Tan Q, Xu L, He T, Lv Q. Application of Carbon Nanoparticles in Tracing Lymph Nodes and Locating Tumors in Colorectal Cancer: A Concise Review. Int J Nanomedicine 2020; 15:9671-9681. [PMID: 33293812 PMCID: PMC7719328 DOI: 10.2147/ijn.s281914] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/22/2020] [Indexed: 02/05/2023] Open
Abstract
Background Accurate lymph node (LN) staging has considerably prognostic and therapeutic value in patients with colorectal cancer (CRC). The purpose of this study is to evaluate the feasibility of applying carbon nanoparticles (CNPs) to track LN metastases in CRC. Methods Two researchers independently screened publications in PubMed, EMBASE, Cochrane and Ovid MEDLINE databases. The keywords were (carbon nanoparticles OR activated carbon nanoparticles) AND (colon cancer OR rectal cancer OR colorectal cancer). Titles and abstracts of the articles were meticulously read to rule out potential publications. Next, full texts of the ultimately obtained eligible publications were retrieved and analyzed in detail. Results The search produced 268 publications, and 140 abstracts were identified after a bibliographic review. Finally, 20 studies relevant to our subject were obtained; however, only 14 papers met our inclusion criteria and were included for final review. All studies included have compared the control group with carbon nanoparticles group (control group, defined as nontattooed group; and carbon nanoparticles group, defined as administering carbon nanoparticles during surgery) for their efficacy in intraoperative detecting and positioning. After analysis, appreciably less amount of bleeding (3/5 trials), shorter operation time (2/4 trials), and shorter time to detect lesions and dissect LNs (2/2 trials) were revealed in CNPs group compared to control group. Thirteen studies have recorded the numbers of the harvested LNs in both groups; meanwhile, CNPs group shows superiority to control group in LN retrieval as well (11/13 trials), which also could effectively aid in locating and harvesting more LNs with diameter below 5 mm. Conclusion The tracing technique for CNPs is a safe and useful strategy both in localizing tumor and tracing LNs in CRC surgery. But there is still a need for more randomized controlled trials to further establish its contribution to patient survival.
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Affiliation(s)
- Pengcheng Liu
- Department of Breast Surgery, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Jie Tan
- Department of Orthopaedic Surgery & Orthopaedic Institute, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Qiuwen Tan
- Department of Breast Surgery, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Li Xu
- Department of Breast Surgery, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Tao He
- Department of Breast Surgery, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Qing Lv
- Department of Breast Surgery, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
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Anayama T, Sato T, Hirohashi K, Miyazaki R, Yamamoto M, Okada H, Orihashi K, Inoue K, Kobayashi M, Yoshida M, Hanazaki K. Near-infrared fluorescent solid material for visualizing indwelling devices implanted for medical use. Surg Endosc 2020; 34:4206-4213. [PMID: 32430529 DOI: 10.1007/s00464-020-07634-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/13/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND In clinical practice, various devices are implanted into the body for medical reasons. As X-ray fluoroscopy is necessary to visualize medical devices implanted into the body, the development of a less-invasive visualization method is highly desired. This study aimed to investigate the clinical applicability of our novel solid material that emits near-infrared fluorescence. METHODS We developed a solid resin material that emits near-infrared fluorescence. This material incorporates a near-infrared fluorescent pigment, with quantum yield ≥ 20 times than that of indocyanine green. It can be sterilized for medical treatment. This resin material is designed to be molded into a catheter and inserted into the body with an endoscope clip. In this preclinical experiment using a swine model, the resin material was embedded into the body of the swine and visualized with a near-infrared fluorescence camera system. RESULTS Endoscopic clips were placed in the mucosa of the stomach, esophagus, and large intestine, and the indwelling ureteral catheters were successfully visualized by near-infrared fluorescence laparoscopy. CONCLUSIONS We confirmed the tissue permeability of the fluorescence emitted by our novel near-infrared fluorescent material and the possibility of its clinical application. This material may allow visualization of devices embedded in the body.
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Affiliation(s)
- Takashi Anayama
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kohasu Oko, Nankoku, 783-8505, Japan.
| | - Takayuki Sato
- Department of Cardiovascular Control, Kochi Medical School, Nankoku, Japan
| | - Kentaro Hirohashi
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kohasu Oko, Nankoku, 783-8505, Japan
| | - Ryohei Miyazaki
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kohasu Oko, Nankoku, 783-8505, Japan
| | - Marino Yamamoto
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kohasu Oko, Nankoku, 783-8505, Japan
| | - Hironobu Okada
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kohasu Oko, Nankoku, 783-8505, Japan
| | | | - Keiji Inoue
- Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Michiya Kobayashi
- Cancer Treatment Center, Kochi Medical School Hospital, Nankoku, Japan
| | - Masashi Yoshida
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Kazuhiro Hanazaki
- Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku, Japan
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Badaracco AG, Ward E, Barback C, Yang J, Wang J, Huang CH, Kim M, Wang Q, Nam S, Delong J, Blair S, Trogler WC, Kummel A. Indocyanine green modified silica shells for colon tumor marking. APPLIED SURFACE SCIENCE 2020; 499:143885. [PMID: 32863496 PMCID: PMC7455021 DOI: 10.1016/j.apsusc.2019.143885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Marking colon tumors for surgery is normally done with the use of India ink. However, non-fluorescent dyes such as India ink cannot be imaged below the tissue surface and there is evidence for physiological complications such as abscess, intestinal perforation and inconsistency of dye injection. A novel infrared marker was developed using FDA approved indocyanine green (ICG) dye and ultrathin hollow silica nanoshells (ICG/HSS). Using a positively charged amine linker, ICG was non-covalently adsorbed onto the nanoparticle surface. For ultra-thin wall 100 nm diameter silica shells, a bimodal ICG layer of < 3 nm is was formed. Conversely, for thicker walls on 2 μm diameter silica shells, the ICG layer was only bound to the outer surface and was 6 nm thick. In vitro testing of fluorescent emission showed the particles with the thinner coating were considerably more efficient, which is consistent with self-quenching reducing emission shown in the thicker ICG coatings. Ex-vivo testing showed that ICG bound to the 100 nm hollow silica shells was visible even under 1.5 cm of tissue. In vivo experiments showed that there was no diffusion of the ICG/nanoparticle marker in tissue and it remained imageable for as long as 12 days.
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Affiliation(s)
- Adrian Garcia Badaracco
- Department of Nanoengineering, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - Erin Ward
- Department of Surgery, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - Christopher Barback
- Department of Radiology, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - Jian Yang
- Department of Chemistry and Biochemistry, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - James Wang
- Department of Nanoengineering, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - Ching-Hsin Huang
- Department of Nanoengineering, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - Moon Kim
- Department of Materials Science and Engineering, The University of Texas at Dallas, 800 West Campbell Road, Richardson, Texas 75080, USA
| | - Qingxiao Wang
- Department of Materials Science and Engineering, The University of Texas at Dallas, 800 West Campbell Road, Richardson, Texas 75080, USA
| | - Seungjin Nam
- Department of Materials Science and Engineering, The University of Texas at Dallas, 800 West Campbell Road, Richardson, Texas 75080, USA
| | - Jonathan Delong
- Department of Surgery, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - Sarah Blair
- Department of Surgery, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - William C Trogler
- Department of Chemistry and Biochemistry, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - Andrew Kummel
- Department of Chemistry and Biochemistry, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
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Milone M, Vignali A, Manigrasso M, Velotti N, Sarnelli G, Aprea G, De Simone G, Maione F, Gennarelli N, Elmore U, De Palma GD. Sterile carbon particle suspension vs India ink for endoscopic tattooing of colonic lesions: a randomized controlled trial. Tech Coloproctol 2019; 23:1073-1078. [PMID: 31667693 DOI: 10.1007/s10151-019-02101-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 10/10/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Different markers have been used preoperatively to mark colonic lesions, especially India ink. In recent years, another kind of marker has been developed: sterile carbon particle suspension (SCPS). No comparison between these two markers has yet been made. The aim of the present study was to compare the pyrogenic, inflammatory and intraperitoneal effect of these two markers. METHODS From September 2015 to December 2018, adult patients who were candidates for elective laparoscopic colon resection were randomized to the SCPS or conventional India ink injection group using computer-based randomization. The primary endpoint of the study was the presence of intraoperative adhesions related to the endoscopic tattoo. Secondary endpoints were differences in white blood cell, C-reactive protein, and fibrinogen levels as well as, abdominal pain and body temperature at baseline (before endoscopic tattooing) and 6 and 24 h after colonoscopy. Finally, the visibility of the tattoo during the minimally invasive intervention was assessed. RESULTS Ninety-four patients were included in the study, 47 for each arm. There were 45/94 females (47.9%) and 49/94 males (52.1%), with a median age of 67.85 ± 9.22 years. No differences were found between groups in WBC, fibrinogen levels, body temperature or VAS scores, but we documented significantly higher CRP values at 6 and 24 h after endoscopic tattooing with India ink injection. There were significantly fewer adhesions in the SCPS Endoscopic Marker group. All the endoscopic tattoos were clearly visible. CONCLUSIONS SCPS is an effective method for tattooing colonic lesions and has a better safety profile than traditional India ink in terms of post-procedure inflammatory response and intraoperative bowel adhesions. CLINICAL TRIAL REGISTRATION clinicaltrials.gov (ID: NCT03637933).
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Affiliation(s)
- M Milone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - A Vignali
- Department of Gastrointestinal Surgery, San Raffaele Hospital and San Raffaele Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - M Manigrasso
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - N Velotti
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - G Sarnelli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - G Aprea
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - G De Simone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - F Maione
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - N Gennarelli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - U Elmore
- Department of Gastrointestinal Surgery, San Raffaele Hospital and San Raffaele Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
| | - G D De Palma
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
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11
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Dua A, Liem B, Gupta N. Lesion Retrieval, Specimen Handling, and Endoscopic Marking in Colonoscopy. Gastrointest Endosc Clin N Am 2019; 29:687-703. [PMID: 31445691 DOI: 10.1016/j.giec.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Retrieval of lesions after endoscopic polypectomy enables histopathologic analysis and guides future surgical management and endoscopic surveillance intervals. Various techniques and devices have been described with distinct advantages and disadvantages to accomplish retrieval. Appropriate histopathologic analysis depends on lesion handling and preparation. How lesions are handled further depends on size, endoscopic appearance, and removal technique. Endoscopic marking or tattooing is a well-described process that uses dye mediums to leave longstanding marks in the colon. Techniques, dye mediums, and locations within the colon influence tattoo approach.
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Affiliation(s)
- Arshish Dua
- Division of Gastroenterology, Loyola University Medical Center, Stritch School of Medicine, 2160 South 1st Avenue, Building 54, Room 167, Maywood, IL 60153, USA
| | - Brian Liem
- Gastroenterology Fellowship, Division of Gastroenterology, Stritch School of Medicine, Loyola University Medical Center, 2160 South 1st Avenue, Building 54, Room 167, Maywood, IL 60153, USA
| | - Neil Gupta
- Digestive Health Program, Division of Gastroenterology, Stritch School of Medicine, Loyola University Medical Center, 2160 South 1st Avenue, Building 54, Room 167, Maywood, IL 60153, USA.
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12
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Woods RW, Camp MS, Durr NJ, Harvey SC. A Review of Options for Localization of Axillary Lymph Nodes in the Treatment of Invasive Breast Cancer. Acad Radiol 2019; 26:805-819. [PMID: 30143401 DOI: 10.1016/j.acra.2018.07.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 02/09/2023]
Abstract
Invasive breast cancer is a common disease, and the most common initial site of metastatic disease are the axillary lymph nodes. As the standard of care shifts towards less invasive surgery in the axilla for patients with invasive breast cancer, techniques have been developed for axillary node localization that allow targeted dissection of specific lymph nodes without requiring full axillary lymph node dissection. Many of these techniques have been adapted from technologies developed for localization of lesions within the breast and include marker clip placement with intraoperative ultrasound, carbon-suspension liquids, localization wires, radioactive seeds, magnetic seeds, radar reflectors, and radiofrequency identification devices.The purpose of this article is to summarize these methods and describe benefits and drawbacks of each method for performing localization of lymph nodes in the axilla.
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13
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Goo JJ, Ryu DG, Kim HW, Park SB, Kang DH, Choi CW, Kim SJ, Nam HS, Kim HS, Son GM, Park BS. Efficacy of preoperative colonoscopic tattooing with indocyanine green on lymph node harvest and factors associated with inadequate lymph node harvest in colorectal cancer. Scand J Gastroenterol 2019; 54:666-672. [PMID: 31071272 DOI: 10.1080/00365521.2019.1612940] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: Adequate lymph node harvest (LNH) in colorectal cancer is closely related to survival. This study aimed to evaluate the effect of preoperative colonoscopic tattooing (PCT) with indocyanine green (ICG) on adequate LNH in colorectal cancer. Materials and methods: A total of 1079 patients who underwent surgical resection for colorectal cancer were divided into two groups: a tattooing group and a non-tattooing group. The patients were retrospectively analyzed for the number and adequacy of LNH according to tumor locations and stages. Univariate and multivariate analysis for factors associated with adequate LNH were done. Results: There was no significant difference between the two groups in the number and adequacy of LNH according to tumor locations. However, T1 colorectal cancer in the tattooing group had significantly higher adequate LNH (91.6% vs 82.1%, OR 2.370, p = .048) and T1 and N0 rectal cancer in the tattooing group also had higher adequate LNH although there was no statistical significance (100% vs 82.4%, OR 12.088, p = .095; 96.9% vs 84.8%, OR 5.570, p = .099) when compared to the non-tattooing group. Male sex and T1 stage were significantly associated with inadequate LNH in multivariate analysis (OR 0.556 (95% CI 0.340-0.909), p = .019; OR 0.555 (95% CI 0.339-0.910), p = .019, respectively). Conclusion: PCT with ICG did not improve adequate LNH in colorectal cancer but effectively improved adequate LNH in early colorectal cancer. Male sex and early cancer were risk factors for inadequate LNH in colorectal cancer, so PCT is needed for adequate LNH in these patients.
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Affiliation(s)
- Ja Jun Goo
- a Department of Internal Medicine , Good Moonwha Hospital , Busan , South Korea
| | - Dae Gon Ryu
- b Department of Internal Medicine , Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan , South Korea
| | - Hyung Wook Kim
- b Department of Internal Medicine , Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan , South Korea
| | - Su Bum Park
- b Department of Internal Medicine , Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan , South Korea
| | - Dae Hwan Kang
- b Department of Internal Medicine , Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan , South Korea
| | - Cheol Woong Choi
- b Department of Internal Medicine , Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan , South Korea
| | - Su Jin Kim
- b Department of Internal Medicine , Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan , South Korea
| | - Hyeong Seok Nam
- b Department of Internal Medicine , Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan , South Korea
| | - Hyun Sung Kim
- c Department of Surgery , Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan , South Korea
| | - Gyung Mo Son
- c Department of Surgery , Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan , South Korea
| | - Byung Soo Park
- c Department of Surgery , Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan , South Korea
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14
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Saklani A, Sugoor P, Chaturvedi A, Bhamre R, Jatal S, Ostwal V, Engineer R. Clinical Utility of Staging Laparoscopy for Advanced Obstructing Rectal Adenocarcinoma: Emerging Tool. Indian J Surg Oncol 2018; 9:488-494. [PMID: 30538377 DOI: 10.1007/s13193-018-0803-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 07/17/2018] [Indexed: 02/07/2023] Open
Abstract
The multimodal treatment for advanced rectal adenocarcinoma mandates accurate preoperative staging with contrast-enhanced computed tomography (CECT) of the thorax, abdomen, and pelvis, and magnetic resonance imaging (MRI) of the pelvis. Unlike gastric cancer, the role of staging laparoscopy (SL) in advanced colorectal cancer has not been evaluated. This study aims to evaluate the clinical value of SL in treatment decision-making for advanced rectal cancer (RC) with near or complete obstructing tumors. Observational review of colorectal database at Tata Memorial Hospital from January 2013 to December 2016 identified 562 patients diagnosed and treated for advanced RC. Of the 562 cases, 48.7% (274) were clinically and radiologically diagnosed of near or complete obstructing advanced RC. Medical records of 34% (94/274) who underwent SL with diversion stoma (DS) were analyzed. In the absence of ascites, extensive peritoneal deposits, and unresectable liver metastases on SL, a curative treatment was offered, which entailed neoadjuvant chemoradiation (NACTRT), whereas the cohort of patients with extensive peritoneal disease received palliative therapy. Of the 94 patients with advanced RC, conventional imaging studies staged 73.5% (69/94) cohort as non-metastatic locally advanced and 26.5% (25/94) had potentially resectable metastatic RC. Pre-therapeutic SL upstaged the disease by 26% (18/69) and 8% (2/25) in locally advanced and potentially resectable metastatic RC cohorts, respectively. Treatment decision changed in 21.2% (20/94) of the patients, and midline laparotomy was thus avoided. In our observational study, SL was found to be a safe and effective staging modality in RC; it detected occult peritoneal disease and prevented midline laparotomy in 21.2% of the cohort, which was of value to determine treatment strategy in patients with advanced RC before initiating NACTRT. SL and laparoscopic-assisted de-functioning stoma were associated with minimal morbidity and led to early initiation of NACTRT.
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Affiliation(s)
- Avanish Saklani
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - P Sugoor
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - A Chaturvedi
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - R Bhamre
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - S Jatal
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - V Ostwal
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India.,2Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - R Engineer
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
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15
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Wilhelm D, Vogel T, Ostler D, Marahrens N, Kohn N, Koller S, Friess H, Kranzfelder M. Enhanced Visualization: From Intraoperative Tissue Differentiation to Augmented Reality. Visc Med 2018; 34:52-59. [PMID: 29594170 DOI: 10.1159/000485940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Optimal visualization of the operative field and methods that additionally provide supportive optical information form the basis for target-directed and successful surgery. This article strives to give an overview of current enhanced visualization techniques in visceral surgery and to highlight future developments. Methods The article was written as a comprehensive review on this topic and is based on a MEDLINE search and ongoing research from our own group and from other working groups. Results Various techniques for enhanced visualization are described comprising augmented reality, unspecific and targeted staining methods, and optical modalities such as narrow-band imaging. All facilitate our surgical performance; however, due to missing randomized controlled studies for most of the innovations reported on, the available evidence is low. Conclusion Many new visualization technologies are emerging with the aim to improve our perception of the surgical field leading to less invasive, target-oriented, and elegant treatment forms that are of significant benefit to our patients.
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Affiliation(s)
- Dirk Wilhelm
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Vogel
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel Ostler
- Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nils Marahrens
- Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nils Kohn
- Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sebastian Koller
- Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Kranzfelder
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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16
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Letarte F, Webb M, Raval M, Karimuddin A, Brown CJ, Phang PT. Tattooing or not? A review of current practice and outcomes for laparoscopic colonic resection following endoscopy at a tertiary care centre. Can J Surg 2017; 60:394-398. [PMID: 28930050 DOI: 10.1503/cjs.004817] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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 colonoscopy preoperatively. In all, 148 patients (66%) had their lesion tattooed at endoscopy. 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 positive margins on final pathology. CONCLUSION To improve surgical planning, we recommend the practice of endoscopic tattooing of all colon lesions at a location just distal to the lesion using multiple injections to cover the circumference of the bowel wall.
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Affiliation(s)
- François Letarte
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (Letarte, Webb, Raval, Karimuddin, Brown, Phang); and the Department of Colorectal Surgery, St. Paul's Hospital, Vancouver, BC (Letarte, Raval, Karimuddin, Brown, Phang)
| | - Mitch Webb
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (Letarte, Webb, Raval, Karimuddin, Brown, Phang); and the Department of Colorectal Surgery, St. Paul's Hospital, Vancouver, BC (Letarte, Raval, Karimuddin, Brown, Phang)
| | - Manoj Raval
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (Letarte, Webb, Raval, Karimuddin, Brown, Phang); and the Department of Colorectal Surgery, St. Paul's Hospital, Vancouver, BC (Letarte, Raval, Karimuddin, Brown, Phang)
| | - Ahmer Karimuddin
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (Letarte, Webb, Raval, Karimuddin, Brown, Phang); and the Department of Colorectal Surgery, St. Paul's Hospital, Vancouver, BC (Letarte, Raval, Karimuddin, Brown, Phang)
| | - Carl J Brown
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (Letarte, Webb, Raval, Karimuddin, Brown, Phang); and the Department of Colorectal Surgery, St. Paul's Hospital, Vancouver, BC (Letarte, Raval, Karimuddin, Brown, Phang)
| | - P Terry Phang
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (Letarte, Webb, Raval, Karimuddin, Brown, Phang); and the Department of Colorectal Surgery, St. Paul's Hospital, Vancouver, BC (Letarte, Raval, Karimuddin, Brown, Phang)
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17
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Simple and reliable method for tumor localization during totally laparoscopic gastrectomy: intraoperative laparoscopic ultrasonography combined with tattooing. Gastric Cancer 2017; 20:548-552. [PMID: 27539582 DOI: 10.1007/s10120-016-0635-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/08/2016] [Indexed: 02/07/2023]
Abstract
We have developed a new method to localize a tumor during totally laparoscopic gastrectomy that uses intraoperative laparoscopic ultrasonography combined with preoperative clipping and tattooing. One or 2 days before the surgery, endoscopic clipping was performed just proximal to the tumor, followed by tattooing with India ink at the clipping site. Examination by intraoperative laparoscopic ultrasonography was performed at the tattooed site to detect the clips. The resection line of the stomach was determined with use of the detected clips as a marker of the proximal margin of the tumor. This method was attempted in 14 patients who underwent totally laparoscopic gastrectomy, and the clips were successfully identified in all patients. The clips were visualized as several layers of a hyperechoic bar, which was termed a "ladder sign." The mean time from insertion of the laparoscopic probe to identification of the clips was 2 min. The ladder sign is an important finding in this method.
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18
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Kim KS, Beck KS, Lee KY, Moon SW. CT localization for a patient with a ground-glass opacity pulmonary nodule expecting thoracoscopy: a mixture of lipiodol and India ink. J Thorac Dis 2017; 9:E349-E353. [PMID: 28523176 DOI: 10.21037/jtd.2017.03.58] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Small and deeply seated pure ground-glass opacity (GGO) pulmonary nodules (PNs) are not discernible during video-assisted thoracoscopic surgery (VATS). Moreover, pathologists have difficulty in detecting these nodules due to insufficient localization. We percutaneously injected a mixture of lipiodol and India ink during preoperative CT-guided localization in a 52-year-old female patient presenting with a pure GGO PN. A black-pigmented tattoo lesion was clearly identified, and thoracoscopic wedge resection was performed without difficulty. Pathologic results were also discernible, thus allowing the target lesion to be identified without interruption for microscopic analysis. We introduce a novel method using a mixture of lipiodol and India ink with satisfactory results for preoperative localization of GGO PNs prior to VATS.
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Affiliation(s)
- Kyung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyongmin Sarah Beck
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyo Young Lee
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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19
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Reynolds IS, Majeed MH, Soric I, Whelan M, Deasy J, McNamara DA. Endoscopic tattooing to aid tumour localisation in colon cancer: the need for standardisation. Ir J Med Sci 2016; 186:75-80. [PMID: 27645221 DOI: 10.1007/s11845-016-1502-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 09/10/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND/AIMS An increasing number of colon and rectal tumours are being resected using laparoscopic techniques. Identifying these tumours intraoperatively can be difficult. The use of tattooing can facilitate an easier resection; however, the lack of standardised guidelines can potentially lead to errors intraoperatively and potentially result in worse outcomes for patients. The aim of this study was to identify the most reliable method of preoperative tumour localisation from the available literature to date. METHODS A literature review was undertaken to identify any articles related to endoscopic tattooing and tumour localisation during colorectal surgery. RESULTS To date there is still mixed evidence regarding tattooing techniques and the choice of ink that should be used. There are numerous studies demonstrating safe tattooing techniques and highlighting the risks and benefits of different types of ink available. CONCLUSION Based on the available studies we have recommended a standardised approach to endoscopic tattooing of colorectal tumours prior to laparoscopic resection.
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Affiliation(s)
- I S Reynolds
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.
| | - M H Majeed
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland
| | - I Soric
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland
| | - M Whelan
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland
| | - J Deasy
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland
| | - D A McNamara
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.
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20
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Wang Q, Chen E, Cai Y, Chen C, Jin W, Zheng Z, Jin Y, Chen Y, Zhang X, Li Q. Preoperative endoscopic localization of colorectal cancer and tracing lymph nodes by using carbon nanoparticles in laparoscopy. World J Surg Oncol 2016; 14:231. [PMID: 27577559 PMCID: PMC5004270 DOI: 10.1186/s12957-016-0987-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 08/17/2016] [Indexed: 02/06/2023] Open
Abstract
Background The objective of this study is to evaluate the effectiveness of preoperative endoscopic localization of colorectal cancer and tracing lymph nodes by carbon nanoparticle tattooing in laparoscopic colorectal cancer surgery. Methods From January 2013 to December 2014, 54 patients with colorectal cancer were recruited and divided into experimental (n = 27) and control (n = 27) groups. The patients in the experimental group were localized preoperatively by endoscopic carbon nanoparticle tattooing, whereas patients in the control group were not tattooed. Results All injection sites in the experimental group were visible to surgeons. No abdominal pain, fever, diarrhea, and other symptoms of infection were found in the experimental group. The time for detecting the tumor (2.71 ± 2.13 min versus 6.91 ± 5.16 min, p < 0.001), operation time (151.22 ± 30.66 min versus 170.26 ± 33.13 min, p = 0.033), and blood loss during the operation (125.04 ± 29.48 mL versus 147.52 ± 34.35 mL, p = 0.013) were lower in the experimental group than in the control group. Average numbers of dissected lymph nodes in the experimental group exceeded those in the control group (14.41 ± 3.32 versus 8.96 ± 2.90, p < 0.001), and the rate of dissected lymph nodes ≥12 was higher in the experimental group than in the control group (70.37 versus 37.04 %, p < 0.001). Moreover, no difference in postoperative complications was found between the two groups. Conclusions Tattooing colorectal cancer with carbon nanoparticles in laparoscopic colorectal cancer surgery is safe and useful both in localization and lymph node tracing.
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Affiliation(s)
- Qingxuan Wang
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Endong Chen
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Yefeng Cai
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Chong Chen
- Department of General Surgery, Pingyang People's Hospital, Wenzhou, Zhejiang Province, 325000, China
| | - Wenxu Jin
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Zhouci Zheng
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Yixiang Jin
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Yao Chen
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Xiaohua Zhang
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China.
| | - Quan Li
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China.
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21
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Szura M, Pasternak A, Solecki R, Matyja M, Szczepanik A, Matyja A. Accuracy of preoperative tumor localization in large bowel using 3D magnetic endoscopic imaging: randomized clinical trial. Surg Endosc 2016; 31:2089-2095. [PMID: 27572063 PMCID: PMC5411410 DOI: 10.1007/s00464-016-5203-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 08/17/2016] [Indexed: 02/06/2023]
Abstract
Background Laparoscopic surgery has become the standard treatment for colorectal cancer. A tumor that does not involve serosa is invisible intraoperatively, and manual palpation of the tumor during laparoscopy is not possible. Therefore, accurate localization of the neoplastic infiltrate remains one of the most important tasks prior to elective laparoscopic surgery. The aim of this study was to evaluate the utility of a magnetic endoscopic imaging (MEI) for precise preoperative endoscopic localization of neoplastic infiltrate within the large bowel. Materials and methods The study enrolled 246 patients who underwent elective surgery for colorectal cancer in 2012–2015 with accurate preoperative colonoscopic localization of the tumor. The analysis concerned patients with neoplastic infiltrate localized more than 30 cm from the anal verge. For evaluative purposes and accuracy of localization, the intestine was divided anatomically into 13 parts. Colonoscopic examinations were conducted with two types of endoscopes: group I—with MEI and group II—without MEI. Patients were assigned to the groups by random allocation. Ultimate confirmation of the tumor localization was accomplished by intraoperative evaluation. Results Group I involved 127 patients and group II 129. The two groups were compared in terms of age, sex, BMI and frequency of previous abdominal procedures. Proper localization of the lesion was confirmed in 95.23 % of group I patients and in 83.19 % of group II patients (p < 0.05). The greatest discrepancy in localization occurred in 8.9 % of patients from group I and 20 % of patients from group II in which the lesion was assessed primarily in the distal sigmoid. Conclusions A magnetic endoscopic imaging allows more accurate localization of neoplastic infiltrate within the large intestine compared to standard colonoscopy alone, especially within the sigmoid colon. This method can be particularly useful in planning and performing laparoscopic procedures to diminish the likelihood of improper bowel segment resection. ClinicalTrials.gov number NCT01688557 Electronic supplementary material The online version of this article (doi:10.1007/s00464-016-5203-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Miroslaw Szura
- Department of Experimental and Clinical Surgery, Jagiellonian University Medical College, 12 Michalowskiego St., 31-126, Kraków, Poland
| | - Artur Pasternak
- First Chair of General, Oncological and Gastrointestinal Surgery, Jagiellonian University Medical College, 40th Kopernika St., 31-501, Kraków, Poland. .,Department of Anatomy, Jagiellonian University Medical College, 12th Kopernika St., 31-034, Kraków, Poland.
| | - Rafal Solecki
- Department of Experimental and Clinical Surgery, Jagiellonian University Medical College, 12 Michalowskiego St., 31-126, Kraków, Poland
| | - Maciej Matyja
- 2nd Chair of General Surgery, Jagiellonian University Medical College, 21st Kopernika St., 31-501, Kraków, Poland
| | - Antoni Szczepanik
- First Chair of General, Oncological and Gastrointestinal Surgery, Jagiellonian University Medical College, 40th Kopernika St., 31-501, Kraków, Poland
| | - Andrzej Matyja
- First Chair of General, Oncological and Gastrointestinal Surgery, Jagiellonian University Medical College, 40th Kopernika St., 31-501, Kraków, Poland
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Colonoscopic localization accuracy for colorectal resections in the laparoscopic era. Am J Surg 2016; 212:258-63. [DOI: 10.1016/j.amjsurg.2015.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 11/02/2015] [Accepted: 12/02/2015] [Indexed: 12/11/2022]
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A comparison of endoscopic localization error rate between operating surgeons and referring endoscopists in colorectal cancer. Surg Endosc 2016; 31:1318-1326. [DOI: 10.1007/s00464-016-5114-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/12/2016] [Indexed: 12/15/2022]
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Aldecoa I, Montironi C, Planell N, Pellise M, Fernandez-Esparrach G, Gines A, Delgado S, Momblan D, Moreira L, Lopez-Ceron M, Rakislova N, Martinez-Palli G, Balust J, Bombi JA, de Lacy A, Castells A, Balaguer F, Cuatrecasas M. Endoscopic tattooing of early colon carcinoma enhances detection of lymph nodes most prone to harbor tumor burden. Surg Endosc 2016; 31:723-733. [PMID: 27324339 PMCID: PMC5266760 DOI: 10.1007/s00464-016-5026-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 06/06/2016] [Indexed: 02/07/2023]
Abstract
Background Colorectal cancer (CRC) screening programs result in the detection of early-stage asymptomatic carcinomas suitable to be surgically cured. Lymph nodes (LN) from early CRC are usually small and may be difficult to collect. Still, at least 12 LNs should be analyzed from colectomies, to ensure a reliable pN0 stage. Presurgical endoscopic tattooing improves LN procurement. In addition, molecular detection of occult LN tumor burden in histologically pN0 CRC patients is associated with a decreased survival rate. We aimed to study the impact of presurgical endoscopic tattooing on the molecular detection of LN tumor burden in early colon neoplasms. Methods A prospective cohort study from a CRC screening-based population was performed at a tertiary academic hospital. LNs from colectomies with and without preoperative endoscopic tattooing were assessed by two methods, hematoxylin and eosin (HE), and RT-LAMP, to detect tumor cytokeratin 19 (CK19) mRNA. We compared the amount of tumor burden and LN yields from tattooed and non-tattooed specimens. Results HE and RT-LAMP analyses of 936 LNs were performed from 71 colectomies containing early carcinomas and endoscopically unresectable adenomas (8 pT0, 17 pTis, 27 pT1, 19 pT2); 47 out of 71 (66.2 %) were tattooed. Molecular positivity correlated with the presence of tattoo in LN [p < 0.001; OR 3.1 (95 % CI 1.7–5.5)]. A significantly higher number of LNs were obtained in tattooed specimens (median 17 LN vs. 14.5 LN; p = 0.019). Conclusions Endoscopic tattooing enables the analysis of those LNs most prone to harbor tumor cells and improves the number of LN harvested. Electronic supplementary material The online version of this article (doi:10.1007/s00464-016-5026-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Iban Aldecoa
- Pathology Department-Centre de Diagnostic Biomedic (CDB), Hospital Clínic, University of Barcelona (CIBERehd) and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Escala 3, Planta 5, Villarroel 170, 08036, Barcelona, Spain
| | - Carla Montironi
- Pathology Department-Centre de Diagnostic Biomedic (CDB), Hospital Clínic, University of Barcelona (CIBERehd) and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Escala 3, Planta 5, Villarroel 170, 08036, Barcelona, Spain
| | | | - Maria Pellise
- Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain
| | - Gloria Fernandez-Esparrach
- Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain
| | - Angels Gines
- Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain
| | | | - Dulce Momblan
- Surgery Department, Hospital Clinic, Barcelona, Spain
| | - Leticia Moreira
- Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain
| | - Maria Lopez-Ceron
- Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain
| | - Natalia Rakislova
- Pathology Department-Centre de Diagnostic Biomedic (CDB), Hospital Clínic, University of Barcelona (CIBERehd) and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Escala 3, Planta 5, Villarroel 170, 08036, Barcelona, Spain
| | | | - Jaume Balust
- Anestesiology Department, ICMDiM, Hospital Clinic-IDIPAPS, Barcelona, Spain
| | - Josep Antoni Bombi
- Pathology Department-Centre de Diagnostic Biomedic (CDB), Hospital Clínic, University of Barcelona (CIBERehd) and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Escala 3, Planta 5, Villarroel 170, 08036, Barcelona, Spain
| | | | - Antoni Castells
- Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain
| | - Miriam Cuatrecasas
- Pathology Department-Centre de Diagnostic Biomedic (CDB), Hospital Clínic, University of Barcelona (CIBERehd) and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Escala 3, Planta 5, Villarroel 170, 08036, Barcelona, Spain.
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Tumor Localization for Laparoscopic Colorectal Resection Without Endoscopic Tattooing. Surg Laparosc Endosc Percutan Tech 2016; 26:230-5. [DOI: 10.1097/sle.0000000000000257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gossedge G, Vallance A, Jayne D. Diverse applications for near infra-red intraoperative imaging. Colorectal Dis 2015; 17 Suppl 3:7-11. [PMID: 26394736 DOI: 10.1111/codi.13023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 05/29/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Near infra-red angiography using Indocyanine Green (ICG) has increasingly used as a tool for intraoperative diagnostics. AIMS The aim of this review is to explore the applications of ICG fluorescence angiography with particular emphasis on general surgical applications. MATERIALS AND METHODS A literature review was conducted to identify and summarise the diverse range of applications of ICG fluorescence. RESULTS ICG fluorescence angiography is increasingly used in a number of general surgical applications, including identification of colorectal liver metastases, assessment of skin flap perfusion, diagnosis of peritoneal endometriosis, ureteric identification, and localisation of colonic pathology. DISCUSSION ICG fluorescence angiography has clinical application in many areas as a tool for guiding surgical resection. CONCLUSION With the technological developments in near infra-red imaging it is likely that ICG fluorescence will play an increasing role in many routine surgical procedures.
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Affiliation(s)
- G Gossedge
- Section of Translational Anaesthesia and Surgical Sciences, Leeds Institute of Biomedical and Clinical Sciences, St James's University Hospital, Leeds, UK
| | - A Vallance
- Section of Translational Anaesthesia and Surgical Sciences, Leeds Institute of Biomedical and Clinical Sciences, St James's University Hospital, Leeds, UK
| | - D Jayne
- Section of Translational Anaesthesia and Surgical Sciences, Leeds Institute of Biomedical and Clinical Sciences, St James's University Hospital, Leeds, UK
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van Leeuwen FWB, Hardwick JCH, van Erkel AR. Luminescence-based Imaging Approaches in the Field of Interventional Molecular Imaging. Radiology 2015; 276:12-29. [PMID: 26101919 DOI: 10.1148/radiol.2015132698] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Luminescence imaging-based guidance technologies are increasingly gaining interest within surgical and radiologic disciplines. Their promise to help visualize molecular features of disease in real time and with microscopic detail is considered desirable. Integrating luminescence imaging with three-dimensional radiologic- and/or nuclear medicine-based preinterventional imaging may overcome limitations such as the limited tissue penetration of luminescence signals. At the same time, the beneficial features of luminescence imaging may be used to complement the routinely used radiologic- and nuclear medicine-based modalities. To fully exploit this integrated concept, and to relate the largely experimental luminesce-based guidance approaches into perspective with routine imaging approaches, it is essential to understand the advantages and limitations of this relatively new modality. By providing an overview of the available luminescence technologies and the various clinically evaluated exogenous luminescent tracers (fluorescent, hybrid, and theranostic tracers), this review attempts to place luminescence-based interventional molecular imaging technologies into perspective to the available radiologic- and/or nuclear medicine-based imaging technologies. At the same time, the transition from anatomic to physiologic and even molecular interventional luminescence imaging is illustrated.
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Affiliation(s)
- Fijs W B van Leeuwen
- From the Department of Radiology, Interventional Molecular Imaging Laboratory and Section of Interventional Radiology (F.W.B.v.L., A.R.v.E.), and Department of Gastroenterology (J.C.H.H.), Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - James C H Hardwick
- From the Department of Radiology, Interventional Molecular Imaging Laboratory and Section of Interventional Radiology (F.W.B.v.L., A.R.v.E.), and Department of Gastroenterology (J.C.H.H.), Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Arian R van Erkel
- From the Department of Radiology, Interventional Molecular Imaging Laboratory and Section of Interventional Radiology (F.W.B.v.L., A.R.v.E.), and Department of Gastroenterology (J.C.H.H.), Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, the Netherlands
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Laparoscopic colon resection: To prep or not to prep? Analysis of 1535 patients. Surg Endosc 2015; 30:2523-9. [PMID: 26304106 DOI: 10.1007/s00464-015-4515-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 08/06/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mechanical bowel preparation (MBP) before elective open colon resection does not reduce the rate of postoperative anastomotic leakage. However, MBP is still routinely used in many countries, and there are very limited data regarding the utility of preoperative MBP in patients undergoing laparoscopic colon resection (LCR). The aim of this study was to challenge the use of MBP before elective LCR. METHODS It is a retrospective analysis of a prospectively collected database. All patients undergoing elective LCR with primary anastomosis and no stoma were included. Preoperative MBP with polyethylene glycol solution was used routinely between April 1992 and December 2004, and then it was abandoned. The early postoperative outcomes in patients who had preoperative MBP (MBP group) and in patients who underwent LCR without preoperative MBP (No-MBP group) were compared. RESULTS From April 1992 to December 2014, 1535 patients underwent LCR: 706 MBP patients and 829 No-MBP patients. There were no differences in demographic data, indication for surgery and type of procedure performed between MBP and No-MBP group patients. The incidence of anastomotic leakage was similar between the two groups (3.4 vs. 3.6 %, p = 0.925). No differences were observed in intra-abdominal abscesses (0.6 vs. 0.8 %, p = 0.734), wound infections (0.6 vs. 1.4 %, p = 0.149), infectious extra-abdominal complications (1.8 vs. 3 %, p = 0.190), and non-infectious complications (6.1 vs. 6.8 %, p = 0.672). The overall reoperation rate was 4.6 % for MBP patients and 5 % for No-MBP patients (p = 0.813). CONCLUSION The use of preoperative MBP does not seem to be associated with lower incidence of intra-abdominal septic complications after LCR.
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Ghersin I, Sroka G, Haj B, Ghersin DS, Matter I. Inadvertent tattooing of adjacent large bowel: a case report and review of literature. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2015; 27:161-2. [PMID: 25004299 PMCID: PMC4678671 DOI: 10.1590/s0102-67202014000200017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 11/23/2013] [Indexed: 11/22/2022]
Affiliation(s)
- Itai Ghersin
- Israel Institute of Technology, Rappaport Faculty of Medicine
| | - Gideon Sroka
- Department of Surgery, Bnai Zion Medical Center, Haifa, Israel
| | - Bassel Haj
- Department of Surgery, Bnai Zion Medical Center, Haifa, Israel
| | | | - Ibrahim Matter
- Department of Surgery, Bnai Zion Medical Center, Haifa, Israel
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Zhuo CH, Shi DB, Ying MG, Cheng YF, Wang YW, Zhang WM, Cai SJ, Li XX. Laparoscopic segmental colectomy for colonic lymphangiomas: A definitive, minimally invasive surgical option. World J Gastroenterol 2014; 20:8745-8750. [PMID: 25024636 PMCID: PMC4093731 DOI: 10.3748/wjg.v20.i26.8745] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 01/29/2014] [Accepted: 03/10/2014] [Indexed: 02/06/2023] Open
Abstract
Colonic lymphangioma is an unusual benign malformation. We herein describe two cases. A 36-year-old woman was admitted with one year of intermittent abdominal pain; colonoscopy, abdominopelvic computed tomography and endoscopic ultrasonography (EUS) revealed enlarged cystic masses at the ascending colon. In another 40-year-old man, colonoscopy and EUS revealed an asymptomatic lobulated cystic mass with four small sessile polyps at the sigmoid colon. Both patients underwent laparoscopic segmental colectomy. Both masses were histologically confirmed as cystic lymphangiomas, and the patients were discharged without complications. The management of colonic lymphangioma depends on the individual situation; close surveillance or endoscopic therapy may be appropriate for asymptomatic lesions smaller than 2.5 cm in diameter. Surgical intervention can be considered for larger lesions or in patients who develop complication risks. Laparoscopic segmental colon resection may be recommended to excise relatively large submucosal lesions because it is a definitive, minimally invasive intervention with a fast postoperative recovery.
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Lee SH, Kim DY, Oh SY, Lee KJ, Suh KW. Preoperative Localization of Early Colorectal Cancer or a Malignant Polyp by Using the Patient's Own Blood. Ann Coloproctol 2014; 30:115-7. [PMID: 24999461 PMCID: PMC4079808 DOI: 10.3393/ac.2014.30.3.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 11/01/2013] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Preoperative localization is the most important preparation for laparoscopic surgery. Preoperative marking with India ink has widely been used and is considered to be safe and effective. However, India ink can cause significant inflammation, adhesions and bowel obstruction. Therefore, we have used the patient's blood instead of the ink since 2011. In this retrospective study, we wanted to examine the feasibility of preoperative localization by using the patient's blood. METHODS Twenty-five patients who underwent preoperative localization in which 10 mL of their own venous blood was used as a tattooing agent were included in this study. The characteristics of the patients, the anatomy of the colon cancer, and the efficacy and the side effects of using this procedure were analyzed. RESULTS In 23 cases (92%), through the laparoscope, we found perfectly localized bloody smudges in the serosa. However, in 2 cases (8%), we could not find the exact location of the lesion. No patients showed any complications. CONCLUSION Preoperative localization of early colon cancer or a malignant polyp by using patient's blood is feasible, safe and simple. We think that using the patient's blood for localization of a lesion is better than using some other foreign material such as India ink.
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Affiliation(s)
- Seung Hwan Lee
- Colon Cancer Center, Ajou University School of Medicine, Suwon, Korea
| | - Do Yoon Kim
- Colon Cancer Center, Ajou University School of Medicine, Suwon, Korea
| | - Seung Yeop Oh
- Colon Cancer Center, Ajou University School of Medicine, Suwon, Korea
| | - Kwang Jae Lee
- Colon Cancer Center, Ajou University School of Medicine, Suwon, Korea
| | - Kwang Wook Suh
- Colon Cancer Center, Ajou University School of Medicine, Suwon, Korea
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Stemmer SM, Shurshalina A. Colonoscopic tattoo dye spillage mimics endometriosis on laparoscopy. J Minim Invasive Gynecol 2014; 21:704-7. [PMID: 24473152 DOI: 10.1016/j.jmig.2014.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 01/20/2014] [Accepted: 01/20/2014] [Indexed: 11/27/2022]
Abstract
Rare adverse effects of India ink injection spillage during colonoscopy have been reported. We present a case report in which prior colonoscopic India ink tattooing was found to mimic intraperitoneal endometriosis in a 48 year-old woman undergoing laparoscopic sterilization. Multiple black lesions suspicious for endometriosis involving the anterior and posterior cul-de-sac, left ovary, and omentum were found. A pathological assessment showed peritoneal tissue with focal dark pigment associated with mild chronic inflammation and deposition of tattoo pigment; there was no evidence of endometriosis in the specimens. Surgical recognition of tattoo ink spillage in the peritoneum is very important to prevent misinterpretation of peritoneal findings.
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Affiliation(s)
- Shlomo M Stemmer
- Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Virtua Hospital, Voorhees, New Jersey
| | - Anna Shurshalina
- Genesis Biotechnology Group, Medical Diagnostic Laboratories L.L.C., Hamilton, New Jersey.
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Karip B, İşcan Y, Ağca B, Fersahoğlu M, Aydın T, Çelik K, Bulut NE, Memişoğlu K. The effect of the endoscopist on the wait-time for colorectal cancer surgery. ULUSAL CERRAHI DERGISI 2014; 30:67-70. [PMID: 25931897 DOI: 10.5152/ucd.2014.2702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 03/13/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The effect of the specialty of physicians who perform endoscopy on preoperative wait-time of colorectal cancer patients was evaluated. MATERIAL AND METHODS Data from 86 patients who have been operated with a diagnosis of colorectal cancer from January 2011-February 2013 regarding age, sex, tumor location, colonoscopy date, surgery date, the expertise and institution of the endoscopist were retrospectively examined. The time between colonoscopy and surgery was accepted as the pre-operative wait time (PWT). RESULTS Out of 86 patients, 24 (27.9%) colonoscopies were performed by general surgeons (GS), and 62 (72.1%) by gastroenterologists (GE). When patients who underwent colonoscopy in other centers were extracted, the PWT for our center was 20.4±10.8 days. When grouped according to specialties, the PWT of patients who had their colonoscopy performed by GS was significantly shorter than patients who underwent colonoscopy by GE at the same center (p<0.05). Patient's age, sex and location of the tumor had no effect on PWT (p>0.05). CONCLUSION The preparation time for surgery in colorectal cancer patients is influenced by the specialty of the physician performing the procedure. In order to standardize this period, a common flow diagram after endoscopy should be established for patients with suspected malignancy.
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Affiliation(s)
- Bora Karip
- Clinic of General Surgery, Fatih Sultan Mehmet Teaching and Training Hospital, İstanbul, Turkey
| | - Yalın İşcan
- Clinic of General Surgery, Fatih Sultan Mehmet Teaching and Training Hospital, İstanbul, Turkey
| | - Birol Ağca
- Clinic of General Surgery, Fatih Sultan Mehmet Teaching and Training Hospital, İstanbul, Turkey
| | - Mahir Fersahoğlu
- Clinic of General Surgery, Fatih Sultan Mehmet Teaching and Training Hospital, İstanbul, Turkey
| | - Timuçin Aydın
- Clinic of General Surgery, Fatih Sultan Mehmet Teaching and Training Hospital, İstanbul, Turkey
| | - Kafkas Çelik
- Clinic of General Surgery, Fatih Sultan Mehmet Teaching and Training Hospital, İstanbul, Turkey
| | - Nuriye Esen Bulut
- Clinic of General Surgery, Fatih Sultan Mehmet Teaching and Training Hospital, İstanbul, Turkey
| | - Kemal Memişoğlu
- Clinic of General Surgery, Fatih Sultan Mehmet Teaching and Training Hospital, İstanbul, Turkey
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Bang CS, Kim YS, Baik GH, Han SH. Colonic Abscess Induced by India Ink Tattooing. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 64:45-8. [DOI: 10.4166/kjg.2014.64.1.45] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Yeon Soo Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Sang Hak Han
- Department of Pathology, Hallym University College of Medicine, Chuncheon, Korea
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Use of endoscopy to prepare patients for surgery. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2013. [DOI: 10.1016/j.tgie.2013.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Van Koughnett JAM, Kalaskar SN, Wexner SD. Pitfalls of laparoscopic colorectal surgery and how to avoid them. COLORECTAL CANCER 2013. [DOI: 10.2217/crc.13.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
SUMMARY Laparoscopic surgery is commonly used for colorectal diseases. Recently, laparoscopy for colorectal carcinoma has increased in use, especially by colorectal surgeons. Laparoscopy is associated with potential pitfalls that pose challenges to the surgeon and team. The identification and management of these pitfalls may not directly parallel those during an open approach. As such, it is essential for the surgeon to have a good working knowledge of how to avoid potential problems and how to best manage them when they do occur. This review highlights common pitfalls of laparoscopic colorectal surgery, as well as offering practical approaches to their management. Technical, patient and surgeon factors are all discussed.
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Affiliation(s)
- Julie Ann M Van Koughnett
- Department of Colorectal Surgery, Cleveland Clinic FL, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
| | - Sudhir N Kalaskar
- Department of Colorectal Surgery, Cleveland Clinic FL, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic FL, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
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Zerey M, Hawver LM, Awad Z, Stefanidis D, Richardson W, Fanelli RD. SAGES evidence-based guidelines for the laparoscopic resection of curable colon and rectal cancer. Surg Endosc 2012; 27:1-10. [PMID: 23239291 DOI: 10.1007/s00464-012-2592-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 06/11/2012] [Indexed: 02/07/2023]
Affiliation(s)
- Marc Zerey
- Department of Surgery, Sansum Clinic, Santa Barbara, CA, USA.
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Bartels SAL, van der Zaag ES, Dekker E, Buskens CJ, Bemelman WA. The effect of colonoscopic tattooing on lymph node retrieval and sentinel lymph node mapping. Gastrointest Endosc 2012; 76:793-800. [PMID: 22835497 DOI: 10.1016/j.gie.2012.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 05/04/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND In colorectal cancer (CRC), colonoscopic tattooing is performed to mark the tumor site before laparoscopic surgery. OBJECTIVE To determine whether colonoscopic tattooing can be used to refine staging accuracy by increasing the lymph node (LN) yield per specimen and to determine its accuracy as a sentinel LN procedure. DESIGN Retrospective, case-control study. All LNs were microscopically examined for the presence of carbon particles. SETTING A university hospital and a teaching hospital. PATIENTS A consecutive series of 95 tattooed patients who had surgery for CRC between 2005 and 2009. A series of 210 non-tattooed patients who had surgery in the same time period served as controls. MAIN OUTCOME MEASUREMENTS Total number of LNs retrieved, detection rate, and sensitivity of tattooing as a sentinel node procedure. RESULTS A higher LN yield was observed in patients with preoperative tattooing, median (interquartile range) 15 (10-20) versus 12 (9-16), (P = .014). In multivariable analysis, the presence of carbon-containing LNs was an independent predictive factor for a higher LN yield (P = .002). The detection rate was 71%, with a median of 5 carbon-containing LNs per specimen. If preoperative tattooing was used for sentinel node mapping, the overall accuracy of predicting LN status was 94%. In the 24 N1 cases, there were 4 false-negative procedures (sensitivity 83%). LIMITATIONS Retrospective series. CONCLUSION After tattooing of CRC, the LN yield was higher than in a control group, and it could be used as a sentinel node procedure with acceptable accuracy rates. Because LN yield and sentinel node mapping are associated with improved diagnostic accuracy of LN involvement, preoperative tattooing can refine staging.
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Affiliation(s)
- Sanne A L Bartels
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
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Should all endoscopically excised rectal polyps be tattooed? A plea for localization. Surg Endosc 2012; 26:3101-5. [PMID: 22692461 DOI: 10.1007/s00464-012-2346-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 04/24/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND More than 5-8 % of endoscopically removed rectal polyps presumed to be benign contain invasive carcinoma. Tattooing has been advocated for follow-up localization of the resection site. Despite proven benefits, the authors propose that tattooing is not routinely performed when benign-appearing rectal polyps are endoscopically excised, thereby confounding management when invasive cancer is found. The secondary goal of the study was to determine the frequency of localization, polyp characteristics, and accuracy of predicting malignant potential at the authors' institution. METHODS All patients with rectal neoplasia discovered during endoscopic polypectomy from 1 January 2003 to 1 August 2010 were retrospectively identified from Temple University Hospital's Tumor Registry. Demographic and clinical data were extracted from medical records including polyp size, gross appearance, pathology, resection margins, location based on preoperative colonoscopy, initial removal technique, tattoo performance, and ensuing procedures. RESULTS During the study period, 49 patients had colonoscopic excision of presumed benign rectal polyps with ensuing diagnosis of neoplasia in the specimen. The malignant histology included adenocarcinoma (n = 5), carcinoma in situ (n = 21), carcinoid (n = 22), and composite carcinoid (n = 1). Only two polyps were tattooed at the initial polypectomy. Three polyps were "suspicious for malignancy." None of the suspicious polyps were tattooed. One of the suspicious lesions was an adenocarcinoma, and the remaining two were benign. The distance from the anal verge was noted in only seven patients. The predominant excision technique was hot snare polypectomy (n = 29). None of the incomplete polyp excisions for 15 patients were "suspicious for malignancy" or tattooed. Several strategies were used to manage incomplete resections including surveillance (40 %), repeat colonoscopic polypectomy (27 %), and surgery (33 %). CONCLUSIONS Most malignant rectal polyps are neither diagnosed nor tattooed at initial colonoscopy. Moreover, the distance of the polyp from the anal verge is rarely measured, and gross characteristics are not well described. Tattooing of all endoscopically excised rectal polypectomy sites would avoid confounding of subsequent identification and management.
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Jeong O, Cho SB, Joo YE, Ryu SY, Park YK. Novel technique for intraoperative tumor localization during totally laparoscopic distal gastrectomy: endoscopic autologous blood tattooing. Surg Endosc 2011; 26:1778-83. [PMID: 22179456 DOI: 10.1007/s00464-011-2067-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 11/10/2011] [Indexed: 12/24/2022]
Abstract
BACKGROUND Knowledge of the intraoperative location of lesions is a prerequisite for deciding the proper extent of gastric resection or the choice of anastomosis technique during totally laparoscopic distal gastrectomy (TLDG) for early gastric cancer (EGC). In this study we introduce a novel tumor localization method for TLDG: endoscopic blood tattooing. METHODS Twenty-three consecutive patients scheduled for TLDG for EGC were enrolled in this prospective study. The day before surgery, 2-3 ml of autologous blood was injected into the gastric muscle layer at 3-4 cm proximal to the lesion during endoscopy. RESULTS The study subjects consisted of 15 males and 8 females with a mean age of 61 ± 10.4 years. During surgery, the endoscopic blood tattooed sites were successfully identified in all 23 patients. No complications associated with the procedure occurred, and no patient had microscopic residual tumor cells at the proximal resection margin, with a mean proximal margin length of 3.3 ± 2.7 cm. Eighteen patients underwent TLDG with Billroth II anastomosis, four patients with Roux-en-Y gastrojejunostomy, and one patient with laparoscopic total gastrectomy. At final pathologic examinations, 20 patients were of stage IA and 3 were of stage IB according to the UICC TNM classification (6th ed.). CONCLUSIONS Endoscopic blood tattooing provides a simple and useful means of localizing lesions during TLDG for EGC. Although the superiority of this technique over other localization methods needs to be evaluated further, the authors recommend endoscopic blood tattooing as an alternative to other intraoperative localization methods for laparoscopic surgery for EGC.
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Affiliation(s)
- Oh Jeong
- Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea
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Conaghan PJ, Maxwell-Armstrong CA, Garrioch MV, Hong L, Acheson AG. Leaving a mark: the frequency and accuracy of tattooing prior to laparoscopic colorectal surgery. Colorectal Dis 2011; 13:1184-7. [PMID: 20860715 DOI: 10.1111/j.1463-1318.2010.02423.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM Intra-operative localization of small cancers and polyps during laparoscopic colorectal surgery is difficult due to reduced tactile feedback. The consequences of failing to identify the lesion for resection can result in open conversion or removal of the wrong segment of bowel. METHOD Data were collected from a prospectively-kept database over a 12-month period from April 2008 to March 2009 and analysed retrospectively. Details concerning the documentation, visibility and accuracy of tattoos were recorded. RESULTS Eighty-five patients (88 lesions) underwent laparoscopic resection for a benign or malignant colorectal tumour during 1 year from April 2008. Eighty-one patients underwent endoscopic visualization of the tumour as a first or second procedure. Of these 81 patients, 83 lesions were visualized endoscopically and 54 (65.1%) were tattooed in 52 patients. In the 52 patients, 36 (69%) of the tattoos were carried out on the first endoscopy. At operation the tattoo was judged to be visible and accurate in 70%, visible but inaccurate in 7% and not visible in 15%. It was significantly easier to see the tattoo in women (19/21 women vs 21/29 men; P=0.03) but there was no relationship between tattoo visibility and BMI. An accurate tattoo did not reduce the conversion rate (P=0.71). No tattoo-related complications were encountered. CONCLUSION The practice of tattooing colorectal cancers is variable in frequency, technique and accuracy. We advocate that all colonic lesions suspicious for cancer should be tattooed during endoscopy at a defined distance below the tumour, adhering to a departmental protocol in case surgery is required.
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Affiliation(s)
- P J Conaghan
- Department of Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
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Moss A, Bourke MJ, Pathmanathan N. Safety of colonic tattoo with sterile carbon particle suspension: a proposed guideline with illustrative cases. Gastrointest Endosc 2011; 74:214-8. [PMID: 21481865 DOI: 10.1016/j.gie.2011.01.056] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Accepted: 01/21/2011] [Indexed: 02/08/2023]
Affiliation(s)
- Alan Moss
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
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Black macular patches on parietal peritoneum and other extraintestinal sites from intraperitoneal spillage and spread of India ink from preoperative endoscopic tattooing: an endoscopic, surgical, gross pathologic, and microscopic study. Dig Dis Sci 2010; 55:2599-605. [PMID: 19957037 DOI: 10.1007/s10620-009-1044-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 10/26/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND Three cases, including one case report and two clinical images, have been reported of extraintestinal or peritoneal black maculae detected at laparoscopy after colonoscopic tattooing, presumably from intraperitoneal spillage of India ink during tattooing. AIMS Report three cases of inadvertent extraintestinal tattooing from endoscopic tattooing of intestinal lesions, provide histologic evidence for the presumed pathophysiology, and promulgate recommendations to prevent this complication. METHODS Three patients underwent endoscopic tattooing of intestinal lesions using India ink, surgery for lesion removal, and pathologic analysis. RESULTS Three patients had black macular patches or streaks identified intraoperatively at extraintestinal sites after endoscopic tattooing of intestinal lesions with India ink: (1) black patches on peritoneum 7 days after colonoscopic tattooing of cecal cancer, (2) black streaks on band connecting cecum to peritoneum 13 days after colonoscopic tattooing of cecal cancer, and (3) blackish band on jejunal mesentery 28 days after tattooing presumptive bleeding jejunal lesion. Pigmentation was detected at both injection and extraintestinal sites in all patients by (1) surgery, (2) gross pathology, and (3) microscopic examination demonstrating intracellular black pigmentation within mesothelial cells and macrophages. Special histologic stains were consistent with a carbon-based pigment, and inconsistent with iron or melanin as the pigment. The proposed mechanism is intraperitoneal India ink spillage from deep intestinal injection, as supported by histologic findings of subserosal pigment accumulation. An alternative histologic mechanism is migration of pigment-laden macrophages via lymphovascular channels. CONCLUSIONS Endoscopic injection of India ink using standard sclerotherapy needles can inadvertently tattoo extraintestinal sites in addition to tattooing the primary lesion. Despite its striking appearance, this intraoperative, gross, and microscopic finding is likely not pathologically significant, given its proposed pathophysiology. Surgical recognition of this entity is important, however, to prevent misinterpretation of findings as peritoneal melanoma, endometrial implants, infarcted mesentery, or tattooed cancer. This complication may be prevented by proper tattooing technique.
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Torres ML, McCafferty MH, Jorden J. The Difficulty with Localization of Rectal Cancer after Neoadjuvant Chemoradiation Therapy. Am Surg 2010. [DOI: 10.1177/000313481007600932] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neoadjuvant chemoradiation therapy (NCRT) has become the standard treatment for locally advanced rectal cancer. Subsequent downstaging can make identification of the primary tumor challenging. Complete pathologic response rates of 8 per cent to 27 per cent are seen with current NCRT regimen. Two patients were referred to our institution after NCRT and subsequent low anterior resection in whom no residual cancer was found in the resected specimen but who manifested cancer in the distal rectum in the early postoperative period. Resection of a locally advanced rectal cancer after NCRT associated with significant tumor shrinkage is facilitated by the surgeon's evaluation with proctoscopy and tumor tattooing before the initiation of NCRT. After NCRT, preoperative proctoscopy, distal rectal evaluation after a sphincter sparing procedure in the operating room, and thorough specimen evaluation help to insure that the surgeon has removed the rectal cancer with an appropriate margin. These cases emphasize how important it is for the surgeon to be involved in the staging phase of managing the patient with rectal cancer.
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