Role of endoscopic tumor tattooing in improving lymph node retrieval of colorectal cancer

Abstract

Background and study aims Adequate lymphadenectomy is crucial to ensure accuracy in staging and treatment of colorectal cancer. Endoscopic preoperative tattooing to mark the location of the tumor has recently been proposed to promote the recovery of lymph nodes in colorectal specimens. The purpose of the study was to evaluate the role of preoperative endoscopic tumor tattooing in improving the retrieval of lymph nodes in colorectal resections. Patients and methods The study was conducted on 100 candidates randomized into two groups. The first group included 50 patients who were injected with black eye dye by colonoscopy done 3–10 days before surgery (tattooed group), and the 50 other patients in the second group (control group) did not have preoperative tattooing. All patients underwent the standard resection under National Comprehensive Cancer Network Colorectal Cancers Guideline. Results The tattooed group showed higher number of lymph nodes retrieved compared with the control group in colon cases and rectum cases. In eight cases, among the patients included in our study, extra-anatomical lymph nodes (outside the standard resection margins) were detected stained. Of these eight cases, two showed malignant deposits. Conclusion Preoperative endoscopic tattooing of colorectal cancers is a safe and easy technique, which proved to have a benefit in improving lymph node retrieval for resected specimens of colorectal cancers either in obese or nonobese patients and also whether they had received or not a preoperative neoadjuvant therapy. There is a connection between lymphatics draining different parts of the colon, as proved by the presence of tattooed lymph nodes outside the standard resection margins. Its clinical significance needs more studies on a larger sample size.