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. 2018 Nov 6;6(13):632-640.
doi: 10.12998/wjcc.v6.i13.632.

Usefulness of colonic tattooing using indocyanine green in patients with colorectal tumors

Jae Ho Park  1 , Hee Seok Moon  2 , In Sun Kwon  3 , Gee Young Yun  1 , Seo Hee Lee  1 , Dae Hwa Park  1 , Ju Seok Kim  1 , Sun Hyung Kang  1 , Eaum Seok Lee  1 , Seok Hyun Kim  1 , Jae Kyu Sung  1 , Byung Seok Lee  1 , Hyun Yong Jeong  1
Affiliations

Usefulness of colonic tattooing using indocyanine green in patients with colorectal tumors

Jae Ho Park et al. World J Clin Cases. .

Abstract

Aim: To prove that tattooing using indocyanine green (ICG) is feasible in laparoscopic surgery for a colon tumor.

Methods: From January 2012 to December 2016, all patients who underwent laparoscopic colonic surgery were retrospectively screened, and 1010 patients with colorectal neoplasms were included. Their lesions were tattooed with ICG the day before the operation. The tattooed group (TG) included 114 patients, and the non-tattooed group (NTG) was selected by propensity score matching of subjects based on age, sex, tumor staging, and operation method (n = 228). In total, 342 patients were enrolled. Between the groups, the changes in [Delta (Δ), preoperative-postoperative] the hemoglobin and albumin levels, operation time, hospital stay, oral ingestion period, transfusion, and perioperative complications were compared.

Results: Preoperative TG had a shorter operation time (174.76 ± 51.6 min vs 192.63 ± 59.9 min, P < 0.01), hospital stay (9.55 ± 3.36 d vs 11.42 ± 8.23 d, P < 0.01), and post-operative oral ingestion period (1.58 ± 0.96 d vs 2.81 ± 1.90 d, P < 0.01). The Δ hemoglobin (0.78 ± 0.76 g/dL vs 2.2 ± 1.18 g/dL, P < 0.01) and Δ albumin (0.41 ± 0.44 g/dL vs 1.08 ± 0.39 g/dL, P < 0.01) levels were lower in the TG. On comparison of patients in the "N0" and "N1 or N2" groups, the N0 colon cancer group had a better operation time, length of hospital stay, oral ingestion period, Δ hemoglobin, and Δ albumin results than those of the N1 or N2 group. The operation methods affected the results, and laparoscopic anterior resection (LAR) showed similar results. However, for left and right hemicolectomy, both groups showed no difference in operation time or hospital stay.

Conclusion: Preoperative tattooing with ICG is useful for laparoscopic colectomy, especially in the N0 colon cancer group and LAR.

Keywords: Colorectal neoplasm; Endoscopic tattoo; Indocyanine green; Laparoscopic surgery; Perioperative.

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Conflict of interest statement

Conflict-of-interest statement: All authors have no conflicts of interest or financial ties to disclose.

Figures

Figure 1
Figure 1
Flow chart of patients enrolled in this study. The 114 tattooed group subjects and the 228 non-tattooed group subjects were selected by propensity score matching. A total of 342 patients was enrolled.
Figure 2
Figure 2
Endoscopic tattooing using indocyanine green. Indocyanine green (ICG) tattooing was performed one day prior to colonoscopic surgery by the circumferential method. A: White light endoscopy image of early sigmoid colon cancer; B: Indigo carmine was used to determine the margin of the lesion; C: Between 1-2 mL of normal saline solution was injected into the submucosa to make an artificial pseudo polyp; D-F: Subsequently, the saline syringe was replaced by the ICG syringe, and 0.5-1 mL of dissolved ICG was injected. ICG: Indocyanine green.
Figure 3
Figure 3
Intraoperative photo. Tattooed area showing a green color (arrow). In the pathologic report, this lesion was 2.3 cm × 1.9 cm in size.
Figure 4
Figure 4
Pathologic specimen of the resected colon. An obvious green color is observed in the inner (A) and outer (B) sides of the colon.
See this image and copyright information in PMC

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