Tumor Localization for Laparoscopic Colorectal Surgery

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2007 May 31

PMID 17534547

Citations 65

Authors

Yong Beom Cho

Woo Yong Lee

Hae Ran Yun

Won Suk Lee

Seong Hyeon Yun

Ho-Kyung Chun

Affiliations

Soon will be listed here.

Abstract

Background: Because palpating colonic tumors during laparoscopy is impossible, the precise location of a tumor must be identified before operation. The aim of this study was to evaluate the accuracy of various diagnostic methods that are used to localize colorectal tumors and to propose an adequate localization protocol for laparoscopic colorectal surgery.

Methods: A total of 310 patients underwent laparoscopy-assisted colectomy between April 2000 and March 2006. We investigated if the locations of the tumors that were estimated preoperatively were consistent with the actual locations according to the operation.

Results: All the tumors were correctly localized and resected. Altogether, 203 patients had complete endoscopic reports available. Colonoscopy was inaccurate for tumor localization in 23 cases (11.3%). In total, 104 patients (33.5%) underwent barium enema; five tumors (4.8%) were not visualized, and three tumors were incorrectly localized. Another group of 94 patients (30.3%) underwent computed tomography (CT) colonography, which identified 91 of 94 lesions (96.8%). Finally, 96 patients (31.0%) underwent endoscopic tattooing; 2 patients (2.1%) did not have tattoos visualized laparoscopically and required intraoperative colonoscopy to localize their lesions during resection. Dye spillage was found in six patients intraoperatively, but only one patient experienced clinical symptoms. Intraoperative colonoscopy was performed in four patients; two of the four were followed by endoscopic tattooing, and the other two underwent intraoperative colonoscopy for localization. All lesions were correctly localized by intraoperative colonoscopy. The accuracy of tumor localization was as follows: colonoscopy (180/203, 88.7%), barium enema (97/104, 93.3%), CT colonography (89/94, 94.7%), endoscopic tattooing (94/96, 97.9%), and intraoperative colonoscopy (4/4, 100%).

Conclusions: With a combination of methods, localization of tumors for laparoscopic surgery did not seem very different from that during open surgery. Preoperative endoscopic tattooing is a safe, highly effective method for localization. In the case of tattoo failure, intraoperative colonoscopy can be used for accurate localization.

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References

Rex D, Rahmani E, Haseman J, Lemmel G, Kaster S, Buckley J . Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. Gastroenterology. 1997; 112(1):17-23. DOI: 10.1016/s0016-5085(97)70213-0. View

Nelson H, Sargent D, Wieand H, Fleshman J, Anvari M, Stryker S . A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004; 350(20):2050-9. DOI: 10.1056/NEJMoa032651. View

Wexner S, Cohen S, Ulrich A, Reissman P . Laparoscopic colorectal surgery--are we being honest with our patients?. Dis Colon Rectum. 1995; 38(7):723-7. DOI: 10.1007/BF02048029. View

Fletcher R . The end of barium enemas?. N Engl J Med. 2000; 342(24):1823-4. DOI: 10.1056/NEJM200006153422409. View

Frager D, Frager J, Wolf E, BENEVENTANO T . Problems in the colonoscopic localization of tumors: continued value of the barium enema. Gastrointest Radiol. 1987; 12(4):343-6. DOI: 10.1007/BF01885178. View

Kim S, Milsom J, Church J, LUDWIG K, Garcia-Ruiz A, Okuda J . Perioperative tumor localization for laparoscopic colorectal surgery. Surg Endosc. 1997; 11(10):1013-6. DOI: 10.1007/s004649900514. View

Pickhardt P, Choi J, Hwang I, Butler J, Puckett M, Hildebrandt H . Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med. 2003; 349(23):2191-200. DOI: 10.1056/NEJMoa031618. View

Vignati P, Welch J, Cohen J . Endoscopic localization of colon cancers. Surg Endosc. 1994; 8(9):1085-7. DOI: 10.1007/BF00705725. View

Botoman V, Pietro M, Thirlby R . Localization of colonic lesions with endoscopic tattoo. Dis Colon Rectum. 1994; 37(8):775-6. DOI: 10.1007/BF02050141. View

10.

Winawer S, STEWART E, Zauber A, Bond J, Ansel H, Waye J . A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. N Engl J Med. 2000; 342(24):1766-72. DOI: 10.1056/NEJM200006153422401. View

11.

Fu K, Fujii T, Kato S, Sano Y, Koba I, Mera K . A new endoscopic tattooing technique for identifying the location of colonic lesions during laparoscopic surgery: a comparison with the conventional technique. Endoscopy. 2001; 33(8):687-91. DOI: 10.1055/s-2001-16217. View

12.

Nizam R, Siddiqi N, Landas S, Kaplan D, Holtzapple P . Colonic tattooing with India ink: benefits, risks, and alternatives. Am J Gastroenterol. 1996; 91(9):1804-8. View

13.

Lacy A, Garcia-Valdecasas J, Delgado S, Castells A, Taura P, Pique J . Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002; 359(9325):2224-9. DOI: 10.1016/S0140-6736(02)09290-5. View

14.

Piscatelli N, Hyman N, Osler T . Localizing colorectal cancer by colonoscopy. Arch Surg. 2005; 140(10):932-5. DOI: 10.1001/archsurg.140.10.932. View

15.

Feingold D, Addona T, Forde K, Arnell T, Carter J, Huang E . Safety and reliability of tattooing colorectal neoplasms prior to laparoscopic resection. J Gastrointest Surg. 2004; 8(5):543-6. DOI: 10.1016/j.gassur.2003.12.016. View

16.

Holzman M, Eubanks S . Laparoscopic colectomy. Prospects and problems. Gastrointest Endosc Clin N Am. 1997; 7(3):525-39. View

17.

McARTHUR C, Roayaie S, Waye J . Safety of preoperation endoscopic tattoo with india ink for identification of colonic lesions. Surg Endosc. 1999; 13(4):397-400. DOI: 10.1007/s004649900997. View

18.

Brady A, Stevenson G, Stevenson I . Colorectal cancer overlooked at barium enema examination and colonoscopy: a continuing perceptual problem. Radiology. 1994; 192(2):373-8. DOI: 10.1148/radiology.192.2.8029400. View