World Journal of Surgery

, Volume 31, Issue 7, pp 1491–1495

Tumor Localization for Laparoscopic Colorectal Surgery

  • Yong Beom Cho
  • Woo Yong Lee
  • Hae Ran Yun
  • Won Suk Lee
  • Seong Hyeon Yun
  • Ho-Kyung Chun
Article
  • 423 Downloads

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.

References

  1. 1.
    Holzman MD, Eubanks S (1997) Laparoscopic colectomy: prospects and problems. Gastrointest Endosc Clin N Am 7:525–539PubMedGoogle Scholar
  2. 2.
    Wexner SD, Cohen SM, Ulrich A, et al. (1995) Laparoscopic colorectal surgery—are we being honest with our patients? Dis Colon Rectum 38:723–727PubMedCrossRefGoogle Scholar
  3. 3.
    Lacy AM, Garcia-Valdecasas JC, Delgado S, et al. (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229PubMedCrossRefGoogle Scholar
  4. 4.
    Color (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059Google Scholar
  5. 5.
    Vignati P, Welch JP, Cohen JL (1994) Endoscopic localization of colon cancers. Surg Endosc 8:1085–1087PubMedCrossRefGoogle Scholar
  6. 6.
    Piscatelli N, Hyman N, Osler T (2005) Localizing colorectal cancer by colonoscopy. Arch Surg 140:932–935PubMedCrossRefGoogle Scholar
  7. 7.
    Rex DK, Rahmani EY, Haseman JH, et al. (1997) Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. Gastroenterology 112:17–23PubMedCrossRefGoogle Scholar
  8. 8.
    Brady AP, Stevenson GW, Stevenson I (1994) Colorectal cancer overlooked at barium enema examination and colonoscopy: a continuing perceptual problem. Radiology 192:373–378PubMedGoogle Scholar
  9. 9.
    Fletcher RH (2000) The end of barium enemas? N Engl J Med 342:1823–1824PubMedCrossRefGoogle Scholar
  10. 10.
    Frager DH, Frager JD, Wolf EL, et al. (1987) Problems in the colonoscopic localization of tumors: continued value of the barium enema. Gastrointest Radiol 12:343–346PubMedCrossRefGoogle Scholar
  11. 11.
    Winawer SJ, Stewart ET, Zauber AG, et al. (2000) A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy: National Polyp Study Work Group. N Engl J Med 342:1766–1772PubMedCrossRefGoogle Scholar
  12. 12.
    Pickhardt PJ, Choi JR, Hwang I, et al. (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349:2191–2200PubMedCrossRefGoogle Scholar
  13. 13.
    Feingold DL, Addona T, Forde KA, et al. (2004) Safety and reliability of tattooing colorectal neoplasms prior to laparoscopic resection. J Gastrointest Surg 8:543–546PubMedCrossRefGoogle Scholar
  14. 14.
    McArthur CS, Roayaie S, Waye JD (1999) Safety of preoperation endoscopic tattoo with India ink for identification of colonic lesions. Surg Endosc 13:397–400PubMedCrossRefGoogle Scholar
  15. 15.
    Fu KI, Fujii T, Kato S, et al. (2001) A new endoscopic tattooing technique for identifying the location of colonic lesions during laparoscopic surgery: a comparison with the conventional technique. Endoscopy 33:687–691PubMedCrossRefGoogle Scholar
  16. 16.
    Nizam R, Siddiqi N, Landas SK, et al. (1996) Colonic tattooing with India ink: benefits, risks, and alternatives. Am J Gastroenterol 91:1804–1808PubMedGoogle Scholar
  17. 17.
    Botoman VA, Pietro M, Thirlby RC (1994) Localization of colonic lesions with endoscopic tattoo. Dis Colon Rectum 37:775–776PubMedCrossRefGoogle Scholar
  18. 18.
    Kim SH, Milsom JW, Church JM, et al. (1997) Perioperative tumor localization for laparoscopic colorectal surgery. Surg Endosc 11:1013–1016PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  • Yong Beom Cho
    • 1
  • Woo Yong Lee
    • 1
  • Hae Ran Yun
    • 1
  • Won Suk Lee
    • 1
  • Seong Hyeon Yun
    • 1
  • Ho-Kyung Chun
    • 1
  1. 1.Department of Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineGangnam-guSouth Korea

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