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Inking outside the box: systematic review on the utility of tattooing lesions in rectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Endoscopic tattooing in rectal cancer is infrequently utilized for fear of tattoo ink obscuring anatomical planes, increasing the difficulty of surgical excision. Colon cancer tattooing has demonstrated increased lymph node yields and increased accuracy in establishing adequate margins. Rectal cancer tattooing may be especially helpful after neoadjuvant chemoradiation, where complete clinical responses could limit lesion identification and lymph node yields are typically less robust. We seek to review and identify the effects of tattooing in rectal cancer.

Methods

A systematic literature search was performed in PubMed, Embase, and SCOPUS. Studies on endoscopic tattooing with cohorts consisting of at least ≥ 25% of rectal cancer patients were selected. Studies focusing solely on rectal cancer were also reviewed separately.

Results

Of 416 studies identified, 10 studies encompassing 2460 patients were evaluated. Seven studies evaluated lymph node yields; five reported beneficial effects of endoscopic tattooing, while two reported no significant difference. Among four studies reporting lesion localization, successful localization rates were between 63 and 100%. Rates of intraoperative endoscopy performed to reevaluate lesion location ranged from 5.7 to 20%. The distal margin was evaluated in two studies, which reported more accurate placement of the distal resection margin after tattooing. When complications of tattooing were documented (7 studies with 889 patients), only five direct complications of endoscopic tattooing were observed (0.6%).

Conclusions

Although the data is heterogenous, it suggests that endoscopic tattooing in rectal cancer may improve lymph node yields and assist in determining accurate distal margins without high rates of complication. Further research must be completed before practice management guidelines can change.

Trial registration

No. CRD42021271784.

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Author information

Authors and Affiliations

  1. Division of Colorectal Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA, 90033, USA

    Jordan Wlodarczyk, Debora Kim, Abhinav Gupta & Marjun Duldulao

  2. Keck School of Medicine, Los Angeles, CA, USA

    Catherine Finney

  3. Department of Surgery, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, CA, USA

    Rebecca Cannom

Authors
  1. Jordan Wlodarczyk
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  2. Debora Kim
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  3. Catherine Finney
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  4. Abhinav Gupta
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  6. Marjun Duldulao
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Contributions

All authors contributed to the study’s conception and design. Jordan Wlodarczyk M.D., M.S. had the idea for the article. Dr. Wlodarczyk, Debora Kim, and Catherine Finney performed the literature search and data analysis. Abhinav Gupta M.D. assisted with edits. All authors contributed to the manuscript draft and critically revised the work.

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Correspondence to Marjun Duldulao.

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Wlodarczyk, J., Kim, D., Finney, C. et al. Inking outside the box: systematic review on the utility of tattooing lesions in rectal cancer. Int J Colorectal Dis 37, 2101–2112 (2022). https://doi.org/10.1007/s00384-022-04239-y

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  • DOI: https://doi.org/10.1007/s00384-022-04239-y

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