Division of Colorectal Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA, 90033, USA.
Keck School of Medicine, Los Angeles, CA, USA.
Int J Colorectal Dis. 2022 Oct;37(10):2101-2112. doi: 10.1007/s00384-022-04239-y. Epub 2022 Aug 31.
Endoscopic tattooing in rectal cancer is infrequently utilized for fear of tattoo ink obscuring anatomical planes, increasing the difficulty of surgical excision. Colon cancer tattooing has demonstrated increased lymph node yields and increased accuracy in establishing adequate margins. Rectal cancer tattooing may be especially helpful after neoadjuvant chemoradiation, where complete clinical responses could limit lesion identification and lymph node yields are typically less robust. We seek to review and identify the effects of tattooing in rectal cancer.
A systematic literature search was performed in PubMed, Embase, and SCOPUS. Studies on endoscopic tattooing with cohorts consisting of at least ≥ 25% of rectal cancer patients were selected. Studies focusing solely on rectal cancer were also reviewed separately.
Of 416 studies identified, 10 studies encompassing 2460 patients were evaluated. Seven studies evaluated lymph node yields; five reported beneficial effects of endoscopic tattooing, while two reported no significant difference. Among four studies reporting lesion localization, successful localization rates were between 63 and 100%. Rates of intraoperative endoscopy performed to reevaluate lesion location ranged from 5.7 to 20%. The distal margin was evaluated in two studies, which reported more accurate placement of the distal resection margin after tattooing. When complications of tattooing were documented (7 studies with 889 patients), only five direct complications of endoscopic tattooing were observed (0.6%).
Although the data is heterogenous, it suggests that endoscopic tattooing in rectal cancer may improve lymph node yields and assist in determining accurate distal margins without high rates of complication. Further research must be completed before practice management guidelines can change.
No. CRD42021271784.
由于担心墨渍会使解剖平面模糊，增加手术切除难度，直肠肿瘤内镜下纹身术的应用并不常见。结肠肿瘤纹身术已证明可以增加淋巴结的检出率，并提高确定适当切缘的准确性。在新辅助放化疗后，直肠肿瘤纹身术可能特别有帮助，因为完全的临床反应可能会限制病变的识别，并且淋巴结的检出通常不太理想。我们旨在综述并确定直肠肿瘤内镜下纹身术的效果。
在 PubMed、Embase 和 SCOPUS 中进行了系统的文献检索。选择了至少有≥25%直肠肿瘤患者的内镜下纹身术的队列研究。还单独对仅关注直肠肿瘤的研究进行了回顾。
在确定的 416 项研究中，评估了 10 项包含 2460 例患者的研究。7 项研究评估了淋巴结的检出率；其中 5 项报告了内镜下纹身术的有益效果，而 2 项报告无显著差异。在 4 项报告病变定位的研究中，成功定位率在 63%至 100%之间。为重新评估病变位置而进行的术中内镜检查的比例为 5.7%至 20%。两项研究评估了远端切缘，报告了纹身术可更准确地放置远端切除切缘。当记录纹身术的并发症（7 项研究共 889 例患者）时，仅观察到 5 例内镜下纹身术的直接并发症（0.6%）。
尽管数据存在异质性，但提示直肠肿瘤内镜下纹身术可能提高淋巴结的检出率，并有助于在不增加并发症发生率的情况下确定准确的远端切缘。在实践管理指南发生变化之前，必须完成进一步的研究。
No. CRD42021271784。
