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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

The authors wanted to prove that tattooing with ICG can be clinically effective if appropriate time and methods are used.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.