Surgical Endoscopy

, Volume 31, Issue 6, pp 2366–2379 | Cite as

Preoperative localization of colorectal cancer: a systematic review and meta-analysis

  • Sergio A. Acuna
  • Maryam Elmi
  • Prakesh S. Shah
  • Natalie G. Coburn
  • Fayez A. QuereshyEmail author



Preoperative colorectal tumor localization is crucial for appropriate resection and treatment planning. As the localization accuracy of conventional colonoscopy is considered to be low, several localization techniques have been developed. We systematically reviewed the tumor localization error rates of several preoperative endoscopic techniques and synthesized information on risk factors for localization errors and procedure-related adverse events.


MEDLINE, EMBASE, the Cochrane Library, and the grey literature were searched. Studies were included if they reported tumor localization errors in patients with colorectal cancer undergoing resection with curative intent. Using random-effects models, pooled incidence of tumor localization errors were derived for conventional colonoscopy and colonoscopic tattooing. Due to the lack of comparative studies, a direct comparison of the pooled estimates was performed. Procedure-related adverse events, risk factors for localization errors, and the localization outcomes of other techniques such as colonoscopic clip placement, radioguided occult colonic lesion identification, and the use of magnetic endoscope imaging were also synthesized.


A total of 38 non-randomized controlled and observational studies were included in this review (2578 patients underwent conventional colonoscopy and 643 colonoscopic tattooing). The pooled incidence of localization errors with conventional colonoscopy was 15.4 % (95 % CI 12.0–18.7), whereas that of colonoscopic tattooing was 9.5 % (95 % CI 5.7–13.3), mean difference 5.9 % (95 % CI 0.65–11.14, p = 0.03). Adverse events secondary to tattooing were infrequent, and most were cases of ink spillage. Limited information was available for other localization techniques.


Conventional colonoscopy has a higher incidence of localization error compared to colonoscopic tattooing for localization of colorectal cancer. Colonoscopic tattooing is safe and leads to fewer tumor localization errors. Given the widespread adoption of laparoscopic resections for colorectal cancer, routine colonoscopic tattooing should be adopted. However, studies directly comparing different localization techniques are needed.


Colonoscopy Colorectal neoplasms Colorectal surgery Preoperative procedures Laparoscopy 



We would like to thank the Information Specialist, Christine Neilson, at the Scotia Bank Health Sciences Library, Li Ki Shing Knowledge Institute, St. Michael’s Hospital, for performing the search presented in this systematic review. We would also like to thank Dr. Fady Saleh for her help in providing data used in this manuscript. Prakesh Shah is supported by an Applied Research Chair in Reproductive and Child Health Services and Policy Research from the Canadian Institutes of Health Research.

Funding source

Dr. Prakesh Shah is supported by an Applied Research Chair in Reproductive and Child Health Services and Policy Research from the Canadian Institutes of Health Research.

Author contributions

Maryam Elmi, Sergio Acuna, Prakesh Shah, Natalie Coburn, and Fayez Quereshy contributed to the study conception and design, analysis and interpretation of data, critical revision, and final approval. Maryam Elmi and Sergio Acuna acquired the data and drafted the manuscript.

Compliance with ethical standards


Sergio A. Acuna, Maryam Elmi, Prakesh S. Shah, Natalie G. Coburn, and Fayez A. Quereshy have no conflicts of interest or financial ties to disclose.

Supplementary material

464_2016_5236_MOESM1_ESM.docx (22 kb)
Supplementary material 1 (DOCX 21 kb)
464_2016_5236_MOESM2_ESM.docx (253 kb)
Supplementary material 2 (DOCX 253 kb)


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Sergio A. Acuna
    • 1
    • 2
  • Maryam Elmi
    • 1
    • 3
  • Prakesh S. Shah
    • 1
    • 4
  • Natalie G. Coburn
    • 1
    • 3
    • 5
  • Fayez A. Quereshy
    • 3
    • 6
    Email author
  1. 1.Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  2. 2.Division of General Surgery, Department of SurgerySt. Michael’s HospitalTorontoCanada
  3. 3.Department of SurgeryUniversity of TorontoTorontoCanada
  4. 4.Departments of PediatricsMount Sinai HospitalTorontoCanada
  5. 5.Division of General SurgerySunnybrook Health Sciences CentreTorontoCanada
  6. 6.Division of General Surgery, Toronto Western HospitalUniversity Health NetworkTorontoCanada

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