Annals of Coloproctology

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Original Article

Preoperative endoscopic tattoo marking improves lymph node retrieval in laparoscopic rectal resection: a retrospective cohort study: Kouki Imaoka, Takuya Yano, Masanori Yoshimitsu, Sotaro Fukuhara, Ko Oshita, Kanyu Nakano, Masaki Kunihiro, Hitoshi Idani, Masazumi Okajima; Ann Coloproctol. 2023;39(2):115-122. Published online September 16, 2021; DOI: https://doi.org/10.3393/ac.2021.00458.0065

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Purpose
Harvesting at least 12 lymph nodes (LNs) is recommended for adequate tumor staging in colon surgery. Although preoperative endoscopic tattooing has been used for primary localization of tumors, its impact on LN retrieval in colorectal surgery remains controversial. We aimed to investigate the relationship between preoperative tattooing and LN retrieval after laparoscopic rectal resection.
Methods
We reviewed the records of 92 patients with rectal cancer who underwent laparoscopic resection from January 1, 2018 to December 31, 2019. Patients were categorized into 2 groups according to whether preoperative endoscopic tattooing was performed. The rate of adequate LN retrieval (≥12) was compared.
Results
The tattooed and non-tattooed groups comprised 49 and 43 patients, respectively. In the tattooed and non-tattooed groups, the rates of adequate LN retrieval were 75.5% and 55.8%, respectively (P=0.046). Univariate analysis revealed that female sex, tattooing, LN metastasis status, pathological pathological stage (p-stage), and LN dissection were predictive factors for adequate LN retrieval. In the multivariate analysis, female sex (odds ratio [OR], 3.34; 95% confidence interval [CI], 1.15–9.73; P=0.027), tattooing (OR, 2.87; 95% CI, 1.03–7.94; P=0.043), and p-stage (OR, 3.34; 95% CI, 1.04–10.75; P=0.043) were independent predictive factors for adequate LN retrieval after surgery.
Conclusion
This study revealed that preoperative endoscopic tattooing was statistically significantly associated with adequate LN retrieval in patients with rectal cancer who underwent laparoscopic rectal resection. Preoperative endoscopic tattooing should be considered to improve disease assessment and avoid stage migration.

Citations

Citations to this article as recorded by

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To what extent does endoscopic tattooing marking boost lymph node retrieval?
Won Beom Jung
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