Abstract
Purpose: The purpose of this study is to evaluate the efficacy of tattooing during colonoscopy to accurately localize colorectal lesions prior to laparoscopic surgery. Methods: We conducted a retrospective chart review of patients receiving tattoos during colonoscopy at MEDSTAR Georgetown University Hospital from January 1, 2000 to May 10, 2012. We identified 50 patients who received tattooing with colonoscopy prior to colorectal surgery. One patient was excluded from analysis due to incomplete data. Patients' records were reviewed to determine rates of accurate identification of endoscopic tattooing during colorectal surgery and surgical pathology. Data regarding indication for colonoscopy, endoscopic findings, endoscopic and surgical pathology were collected. Results: Fifty patients (mean age 64.8 yrs, range 28-89; male 23 [46%], female 27 [54%]) were identified as having tattooing with colonoscopy for identification of lesions for subsequent colorectal surgery. Of the 40 patients that had tattooing for localization of tumor, 15 (37.5%) were located in the sigmoid colon, 15 (37.5%) right colon, 3 (7.5%) rectum, 5 (12.5%) left colon, and 2 (5%) transverse colon. Ten patients had tattooing for other colonic pathology, including 6 for sigmoid diverticulosis, 3 for strictures, and 1 for sigmoid inflammation. Out of 49 patients with complete records, there were 24 (49%) patients with tattoo markings visualized during colorectal surgery and on surgical pathology, 8 (16%) during surgery but not on pathology, 5 (10%) on pathology but not during surgery, and 12 (24%) had no tattoo markings visualized during surgery or on pathology. However, in all 12 (24%) cases, surgical pathology demonstrated successful resection of colonic lesions. On surgical pathology, there were 28 (57%) adenocarcinomas, 6 (12%) benign, 5 (10%) adenomas, 1 (2%) metastatic cancer, 1 (2%) lipoma and 8 (16%) other (diverticulosis, inflammation or abscess). No tattoo related complications were noted. There were no conversions from laparoscopic to open surgical resection due to poorly visualize tattooed lesions. Conclusion: Overall, tattooing was visualized in 32 (65%) of surgeries and 29 (59%) of surgical pathology. Endoscopic tattooing was identified both during surgery and on pathology in 24 (49%) patients, therefore establishing a strong correlation between tattooing and accurate resection. Majority of tattooed lesions were adenocarcinoma (28, 57%), confirming the importance of tattooing in colorectal cancer resection. All colonic lesions that appear to be malignant should be tattooed during endoscopy to improve surgical localization. Tattoo endoscopy is a safe and effective method for preoperative tumor localization.
Published Version
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