Acuna Sergio A, Elmi Maryam, Shah Prakesh S, Coburn Natalie G, Quereshy Fayez A
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Division of General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada.
Surg Endosc. 2017 Jun;31(6):2366-2379. doi: 10.1007/s00464-016-5236-8. Epub 2016 Oct 3.
Preoperative colorectal tumor localization is crucial for appropriate resection and treatment planning. As the localization accuracy of conventional colonoscopy is considered to be low, several localization techniques have been developed. We systematically reviewed the tumor localization error rates of several preoperative endoscopic techniques and synthesized information on risk factors for localization errors and procedure-related adverse events.
MEDLINE, EMBASE, the Cochrane Library, and the grey literature were searched. Studies were included if they reported tumor localization errors in patients with colorectal cancer undergoing resection with curative intent. Using random-effects models, pooled incidence of tumor localization errors were derived for conventional colonoscopy and colonoscopic tattooing. Due to the lack of comparative studies, a direct comparison of the pooled estimates was performed. Procedure-related adverse events, risk factors for localization errors, and the localization outcomes of other techniques such as colonoscopic clip placement, radioguided occult colonic lesion identification, and the use of magnetic endoscope imaging were also synthesized.
A total of 38 non-randomized controlled and observational studies were included in this review (2578 patients underwent conventional colonoscopy and 643 colonoscopic tattooing). The pooled incidence of localization errors with conventional colonoscopy was 15.4 % (95 % CI 12.0-18.7), whereas that of colonoscopic tattooing was 9.5 % (95 % CI 5.7-13.3), mean difference 5.9 % (95 % CI 0.65-11.14, p = 0.03). Adverse events secondary to tattooing were infrequent, and most were cases of ink spillage. Limited information was available for other localization techniques.
Conventional colonoscopy has a higher incidence of localization error compared to colonoscopic tattooing for localization of colorectal cancer. Colonoscopic tattooing is safe and leads to fewer tumor localization errors. Given the widespread adoption of laparoscopic resections for colorectal cancer, routine colonoscopic tattooing should be adopted. However, studies directly comparing different localization techniques are needed.
术前结直肠肿瘤定位对于恰当的切除及治疗规划至关重要。由于传统结肠镜检查的定位准确性被认为较低，已开发出多种定位技术。我们系统回顾了几种术前内镜技术的肿瘤定位错误率，并综合了定位错误的危险因素及与操作相关的不良事件的信息。
检索了MEDLINE、EMBASE、Cochrane图书馆及灰色文献。纳入的研究需报告接受根治性切除的结直肠癌患者的肿瘤定位错误情况。使用随机效应模型得出传统结肠镜检查及结肠镜下纹身的肿瘤定位错误合并发生率。由于缺乏比较研究，对合并估计值进行了直接比较。还综合了与操作相关的不良事件、定位错误的危险因素以及其他技术（如结肠镜下夹子放置、放射性引导隐匿性结肠病变识别及磁性内镜成像的应用）的定位结果。
本综述共纳入38项非随机对照和观察性研究（2578例患者接受传统结肠镜检查，643例接受结肠镜下纹身）。传统结肠镜检查定位错误的合并发生率为15.4%（95%可信区间12.0 - 18.7），而结肠镜下纹身的为9.5%（95%可信区间5.7 - 13.3），平均差异为5.9%（95%可信区间0.65 - 11.14，p = 0.03）。纹身继发的不良事件很少见，大多数是墨水溢出的情况。关于其他定位技术的信息有限。
对于结直肠癌的定位，传统结肠镜检查的定位错误发生率高于结肠镜下纹身。结肠镜下纹身安全且导致的肿瘤定位错误更少。鉴于腹腔镜切除在结直肠癌中的广泛应用，应采用常规结肠镜下纹身。然而，需要进行直接比较不同定位技术的研究。
