Division of Colorectal Surgery, Keck School of Medicine, Los Angeles, California; Division of General Surgery, Keck School of Medicine, Los Angeles, California.
Keck School of Medicine, Los Angeles, California.
J Surg Res. 2023 Jan;281:37-44. doi: 10.1016/j.jss.2022.08.013. Epub 2022 Sep 14.
Preoperative endoscopic tattooing is an effective tool for intraoperative tumor localization in colon cancer. Endoscopic tattooing in rectal cancer may have unidentified benefits on lymph node yield, making it easier for pathologists to identify nodes during histopathologic assessment. There remains concern that tattoo ink may alter anatomical planes, increasing surgical difficulty.
Retrospective chart reviews from 2016 to 2021 of n = 170 patients presenting with rectal cancer were divided into two groups: with (n = 79) and without (n = 91) endoscopic tattoos. Demographics, operative details, tumor characteristics, prior chemoradiation, and pathologic details were collected. Primary outcome was total lymph node yield. Secondary outcomes were rates of adequate (> 12) nodes, margin status, and operative variables including operative time.
No differences between pathologic stage, tumor height, high inferior mesenteric artery ligation, operative times, conversion rate, or surgical approach (open versus minimally invasive) were noted between groups. Receipt of neoadjuvant chemoradiation was less frequent in the endoscopic tattooing group (53.2% versus 76.9%, P ≤ 0.001). Total node number and rate of adequate lymph node yield were higher with endoscopic tattooing (20.5 ± 7.6 versus 16.8 ± 6.6 lymph nodes and 100.0% versus 83.5% adequate lymph node harvest, both P ≤ 0.001). Rates of positive circumferential and distal margins and complete total mesorectal excision were also similar. Regression analysis identified endoscopic tattooing (Incidence Risk Ratio 1.17, 95% confidence interval 1.04-1.31) and operative time more than 300 min (Incidence Risk Ratio 0.88, 95% confidence interval 0.77-0.99) had significant effects on lymph node harvest. Removal of patients with inadequate lymph node yield resulted in similar rates of total and positive lymph nodes.
Endoscopic rectal tattooing is associated with increased lymph node yield (including after neoadjuvant chemoradiotherapy) without sacrificing oncologic or perioperative outcomes, although this effect is inconsistent when only considering patients with an adequate lymph node yield.
术前内镜下纹身是结肠癌术中肿瘤定位的有效工具。直肠癌内镜下纹身可能对淋巴结产量有未知的益处，使病理学家在组织病理学评估中更容易识别淋巴结。仍有人担心墨汁可能会改变解剖平面，增加手术难度。
回顾 2016 年至 2021 年期间 170 例直肠腺癌患者的病历，将其分为两组：有（n=79）和无（n=91）内镜纹身。收集人口统计学、手术细节、肿瘤特征、术前放化疗以及病理详细资料。主要结果是总淋巴结产量。次要结果是足够（>12 个）淋巴结的比率、切缘状态和手术变量，包括手术时间。
两组之间在病理分期、肿瘤高度、肠系膜下动脉高位结扎、手术时间、转化率或手术方式（开放与微创）方面无差异。内镜纹身组接受新辅助放化疗的频率较低（53.2%比 76.9%，P≤0.001）。内镜纹身组的总淋巴结数和足够淋巴结产量的比例较高（20.5±7.6 比 16.8±6.6 个淋巴结和 100.0%比 83.5%的足够淋巴结收获，均 P≤0.001）。阳性环周和远端切缘以及完整的全直肠系膜切除术的比例也相似。回归分析发现内镜纹身（发生率风险比 1.17，95%置信区间 1.04-1.31）和手术时间超过 300 分钟（发生率风险比 0.88，95%置信区间 0.77-0.99）对淋巴结收获有显著影响。排除淋巴结产量不足的患者后，总淋巴结和阳性淋巴结的比例相似。
内镜直肠纹身可增加淋巴结产量（包括新辅助放化疗后），而不影响肿瘤学或围手术期结果，尽管当仅考虑淋巴结产量足够的患者时，这种效果并不一致。
