Published online Nov 6, 2018. doi: 10.12998/wjcc.v6.i13.632
Peer-review started: July 6, 2018
First decision: August 25, 2018
Revised: August 31, 2018
Accepted: October 8, 2018
Article in press: October 9, 2018
Published online: November 6, 2018
Processing time: 124 Days and 1.8 Hours
Endoscopic marking of colonic lesions has become more important in recent years when laparoscopic surgery has become the mainstream. A less complicated, simple, and effective tattooing method was required. The authors aimed to prove that tattooing using indocyanine green (ICG) is beneficial in laparoscopic surgery of colon tumor.
Although tattooing using India ink has been used for colon tumor location, adhesion due to local inflammation is a problem, and granulation or abscess formation may occur when transabdominal spillage. ICG is a safe substance used in the i.v. injection for liver function assessment, but it is less used due to its shorter duration. ICG can be used effectively at appropriate intervals until surgery.
The authors wanted to prove that tattooing with ICG can be clinically effective if appropriate time and methods are used.
The tattooed group (TG) contained 114 patients, and the non-tattooed group (NTG) comprised 228 patients selected by propensity score matching of subjects based on age, sex, tumor staging, and operation method. Between the groups, the perioperative parameters were compared. To compensate for the difference in the operation time due to lymph node dissection in the advanced stage, lymph node positive (N1 or N2) and negative (N0) groups were compared, especially T1N0, T1N1 or T1N2. To investigate the differences in results according to the surgical method, each surgical method was compared.
Without major complications, all tattooed lesions are safely resected. Perioperative operation times, hospital stays, and oral ingestion periods were shorter in the TG. The Δ hemoglobin and Δ albumin showed less intraoperative blood loss in the tattooed group. With or without lymph node metastasis, tattooing has a significant effect of reducing the amount of blood loss by preventing the resection of unnecessary parts. Especially in patients without lymph node dissection, other perioperative parameters showed better results. When classified according to type of surgery, there were statistically significant differences in operative time and other parameters in the LAR group.
Tattooing using ICG is a simple and effective method with few complications and can be used in laparoscopic colon surgery, especially in the N0 colon cancer and LAR groups.
Based on results from perioperative data, if the time to surgery and the injection method are appropriate, colonoscopic tattooing with ICG was shown to be effective with limited complications.