Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2018; 6(13): 632-640
Published online Nov 6, 2018. doi: 10.12998/wjcc.v6.i13.632
Usefulness of colonic tattooing using indocyanine green in patients with colorectal tumors
Jae Ho Park, Hee Seok Moon, In Sun Kwon, Gee Young Yun, Seo Hee Lee, Dae Hwa Park, Ju Seok Kim, Sun Hyung Kang, Eaum Seok Lee, Seok Hyun Kim, Jae Kyu Sung, Byung Seok Lee, Hyun Yong Jeong
Jae Ho Park, Hee Seok Moon, Gee Young Yun, Seo Hee Lee, Dae Hwa Park, Ju Seok Kim, Sun Hyung Kang, Eaum Seok Lee, Seok Hyun Kim, Jae Kyu Sung, Byung Seok Lee, Hyun Yong Jeong, Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University college of Medicine, Daejeon 35015, South Korea
In Sun Kwon, Clinical Trials Center, Chungnam National University Hospital, Daejeon 35015, South Korea
Author contributions: Park JH collected and analyzed the data and wrote the manuscript; Moon HS designed, organized, and supervised the writing of the manuscript; Jeong HY, Lee BS, and Sung JK helped with data interpretation that was used in the current study; Kim SH, Lee ES, Kang SH and Kim JS provided input and organized the data for statistical analysis; Park DH, Lee SH, and Yun GY helped with data analysis; Kwon IS provided advice for the statistical analysis; all of the authors approved the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Chungnam National University Hospital Institutional Review Board, No. CNUH 2017-12-026.
Informed consent statement: This study is a retrospective study using medical records, and personal information protection measures are appropriately established so that the informed consent of the subject can be exempted.
Conflict-of-interest statement: All authors have no conflicts of interest or financial ties to disclose.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hee Seok Moon, MD, PhD, Professor, Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon 35015, South Korea. mhs1357@cnuh.co.kr
Telephone: +82-42-2807186 Fax: +82-42-2544553
Received: July 5, 2018
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
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, Laparoscopic surgery, Endoscopic tattoo, Indocyanine green, Perioperative

Core tip: As minimally invasive surgery becomes the main trend, endoscopic tattooing of colonic lesions has become important. Colonoscopic tattooing using indocyanine green (ICG) was performed in this study, resulting in a reduction in the operation time, blood loss, and the number of hospital days in patients in the N0 group. Multivariate analysis was conducted. There was strong evidence that after controlling for other variables, the tattooing procedure using ICG was associated with reduced blood loss and post-operative bowel recovery. Thus, colonoscopic tattooing using ICG is helpful in laparoscopic colectomy.