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

Jordan Wlodarczyk; Debora Kim; Catherine Finney; Abhinav Gupta; Rebecca Cannom; Marjun Duldulao

doi:10.1007/s00384-022-04239-y

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

Int J Colorectal Dis. 2022 Oct;37(10):2101-2112. doi: 10.1007/s00384-022-04239-y. Epub 2022 Aug 31.

Authors

Jordan Wlodarczyk¹, Debora Kim¹, Catherine Finney², Abhinav Gupta¹, Rebecca Cannom³, Marjun Duldulao⁴

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.
² Keck School of Medicine, Los Angeles, CA, USA.
³ Department of Surgery, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, CA, USA.
⁴ Division of Colorectal Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA, 90033, USA. Marjun.Duldulao@med.usc.edu.

PMID: 36044044
DOI: 10.1007/s00384-022-04239-y

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.

Keywords: Colorectal cancer tattoo; Endoscopic tattooing; Lymph node yield; Rectal cancer; Rectal cancer tattoo; Rectal tattoo.

Publication types

Review
Systematic Review

MeSH terms

Colonic Neoplasms* / surgery
Humans
Ink
Rectal Neoplasms* / pathology
Rectal Neoplasms* / surgery
Retrospective Studies
Tattooing* / adverse effects