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Mun JY, An H, Yoo RN, Cho HM, Kye BH. Preoperative localization of potentially invisible colonic lesions on the laparoscopic operation field: using autologous blood tattooing. Ann Coloproctol 2024; 40:225-233. [PMID: 38946093 DOI: 10.3393/ac.2023.00059.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/01/2023] [Indexed: 07/02/2024] Open
Abstract
PURPOSE Preoperative colonoscopic (POC) localization is recommended for patients scheduled for elective laparoscopic colectomy for early colon cancer. Among the various localization method, POC tattooing localization has been widely used. Several dyes have been used for tattooing, but dye has disadvantages, including foreign body reactions. For this reason, we have used autologous blood tattooing for POC localization. This study aimed to evaluate the safety and efficacy of the autologous blood tattooing method. METHODS This study included patients who required POC localization of the colonic neoplasm among the patients who were scheduled for elective colon resection. The indication for localization was early colon cancer (clinically T1 or T2) or colonic neoplasms that could not be resected endoscopically. POC autologous blood tattooing was performed after saline injection, and 2 hemoclips were applied. RESULTS A total of 45 patients who underwent autologous blood tattooing and laparoscopic colectomy were included in this study. All POC localization sites were visible in the laparoscopic view. POC localization sites showed almost perfect agreement with intraoperative surgical findings. There were no complications like bowel perforation, peritonitis, hemoperitoneum, and mesenteric hematoma. CONCLUSION Autologous blood is a safe and effective agent for localizing materials that can replace previous dyes. However, a large prospective case-control study is required for the routine application of this procedure in early colon cancer or colonic neoplasms.
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Affiliation(s)
- Ji Yeon Mun
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hyunjoon An
- Department of Surgery, Daehang Hospital, Seoul, Korea
| | - Ri Na Yoo
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon-Min Cho
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Bong-Hyeon Kye
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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Baral JEM, Kouladouros K. Completion Surgery after Non-Curative Local Resection of Early Rectal Cancer. Visc Med 2024; 40:144-149. [PMID: 38873629 PMCID: PMC11166898 DOI: 10.1159/000538840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/10/2024] [Indexed: 06/15/2024] Open
Abstract
Background The expanding indications of local - endoscopic and transanal surgical - resection of early rectal cancer has led to their increased popularity and inclusion in the treatment guidelines. The accuracy of the current diagnostic tools in identifying the low-risk T1 tumors that can be curatively treated with a local resection is low, and thus several patients require additional oncologic surgery with total mesorectal excision (TME). An efficient clinical strategy which avoids overtreatment and obstacle surgical procedures is under debate between different disciplines. Summary Completion surgery has comparable outcomes to primary surgery regarding perioperative morbidity and mortality but also recurrence rates and overall survival. However, local scarring in the mesorectum can make mesorectal excision technically challenging, especially after full-thickness resections, and has been associated with increased rates of permanent ostomy and worse quality of the TME specimen. This risk seems to be lower after muscle-sparing procedures like endoscopic submucosal dissection, which seem to show a benefit in comparison to full-thickness resections. Key Messages Completion surgery after non-curative local resection of gastrointestinal malignancies is safe and feasible. Full-thickness resection techniques can cause scarring of the mesorectum; therefore, muscle-sparing procedures should be preferred.
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Affiliation(s)
| | - Konstantinos Kouladouros
- Central Interdisciplinary Endoscopy, Department of Hepatology and Gastroenterology, Charité University Hospital Berlin – Campus Virchow Klinikum, Berlin, Germany
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Roy H, Johnson G, Singh H, Hyun E, Moffatt D, Vergis A, Helewa R. Implementation of Synoptic Reporting for Endoscopic Localization of Complex Colorectal Neoplasms. Cureus 2024; 16:e54480. [PMID: 38524081 PMCID: PMC10957508 DOI: 10.7759/cureus.54480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Lack of documented tattooing of colorectal neoplasms at index colonoscopy results in high repeat preoperative colonoscopy rates. We developed national consensus recommendations for endoscopic localization and piloted an electronic synoptic reporting template. We report on the implementation and perceptions of using synoptic reporting to enhance colorectal lesion marking in a central Canadian healthcare system. Methods We implemented the template within our endoscopy reporting system and ran an infographic education campaign. We then conducted a follow-up email-based interview with all regional endoscopists. Thematic analysis and a mixed-methods triangulation approach were employed to synthesize qualitative and quantitative data. Results The interview was completed by 28/52 endoscopists (54%). Most (60.7%; n = 17) completed >100 colonoscopies and 71.4% (n = 20) identified six to 20 neoplasms requiring tattooing since introduction. A total of 50% (n = 14) used the template. Those not using it were unaware of it (42.9%; n = 12), or preferred using narrative text (17.9%; n = 5). Users reported modest mean functionality scores (intuitiveness: 3.56/5; efficiency: 3.7/5) and high impact scores (credible: 4.22/5; informative: 4.21/5). However, the perception of the synoptic template's ability to reduce the repeat preoperative colonoscopy rate was more circumspect (3.76/5). Conclusions Endoscopists believed the synoptic template was a functional, impactful tool that would improve communication and help to decrease the repeat preoperative colonoscopy rate. However, synoptic template uptake was limited by provider awareness, therefore more educational efforts are needed to increase uptake.
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Affiliation(s)
- Haven Roy
- Surgery, University of Manitoba, Winnipeg, CAN
| | | | | | - Eric Hyun
- Surgery, University of Manitoba, Winnipeg, CAN
| | - Dana Moffatt
- Internal Medicine, University of Manitoba, Winnipeg, CAN
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Hershorn O, Park J, Singh H, Restall GJ, Clouston KM, Vergis AS, Helewa RM. Variability in Communication and Reporting Practices Between Gastroenterologists and General Surgeons Contributes to Repeat Preoperative Endoscopy for Colorectal Neoplasms: A Qualitative Analysis. Dis Colon Rectum 2023; 66:155-162. [PMID: 34933315 DOI: 10.1097/dcr.0000000000002213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Surgeons commonly repeat preoperative endoscopy before planned colorectal resections. The reasons for this are not entirely clear, and repeat endoscopy may lead to delays in curative resection, increased costs, and patient discomfort. OBJECTIVE This study aimed to determine practice patterns, localization techniques, and processes of communication undertaken by endoscopy specialists in a high-volume regional health authority. DESIGN This was a qualitative study involving standardized, semi-structured, in-depth interviews that were conducted in person. Data were analyzed using a thematic analysis approach. SETTINGS The study was conducted at Canadian tertiary and community facilities. PARTICIPANTS Ten general surgeons and 10 gastroenterologists were included using a convenience sampling technique. MAIN OUTCOME MEASURES Interview questions were developed to understand the perspectives and practice patterns of endoscopists when approaching patients diagnosed with colorectal lesions requiring surgical resection. The decision-making process to perform a repeat preoperative endoscopy was assessed. RESULTS Three key themes emerged: 1) patterns of communication, 2) feedback, and 3) trust. Thematic analysis revealed that poor communication and ambiguous documentation increased the likelihood of performing repeat preoperative endoscopy. Inconsistencies in tattooing practices and lesion location were important factors. Negative experiences and factors related to interprofessional trust emerged as key contributors to repeat preoperative endoscopy. LIMITATIONS The transferability of findings to health care systems outside Canada may be limited and requires further study. CONCLUSIONS Suboptimal endoscopic reporting contributes to gaps in communication among endoscopists. In addition, lack of consistent feedback and mutual trust may increase the likelihood of performing repeat preoperative lower endoscopy. Inconsistent tattooing practices pose significant concerns for accurate intraoperative lesion localization. Establishing collaborative work environments through joint educational initiatives may enhance communication and mitigate unnecessary repeat procedures. These results support the need for standardized guidelines and endoscopic reporting in the management of colorectal lesions. See Video Abstract at http://links.lww.com/DCR/B879 . LA VARIABILIDAD EN LAS PRCTICAS DE COMUNICACIN Y PRESENTACIN DE INFORMES ENTRE GASTROENTERLOGOS Y CIRUJANOS GENERALES CONTRIBUYE A REPETIR LA ENDOSCOPIA PREOPERATORIA PARA LAS NEOPLASIAS COLORRECTALES UN ANLISIS CUALITATIVO ANTECEDENTES:Los cirujanos suelen repetir la endoscopia preoperatoria antes de las resecciones colorrectales planificadas. Las razones de esto no están del todo claras y la repetición de la endoscopia puede provocar retrasos en la resección curativa, aumento de los costos y malestar del paciente.OBJETIVO:Nuestro objetivo fue determinar patrones de práctica, técnicas de localización y procesos de comunicación realizados por especialistas en endoscopia, en una autoridad sanitaria regional, de alto volumen.DISEÑO:Este fue un estudio cualitativo, que involucró entrevistas estandarizadas, semiestructuradas y en profundidad que se llevaron a cabo en persona. Los datos se analizaron mediante un enfoque de análisis temático.ENTORNO CLINICO:El estudio se llevó a cabo en instalaciones comunitarias y terciarias canadienses.PARTICIPANTES:Se incluyeron 10 cirujanos generales y 10 gastroenterólogos, utilizando una técnica de muestreo por conveniencia.PRINCIPALES MEDIDAS DE VALORACION:Las preguntas de la entrevista se desarrollaron para comprender las perspectivas y los patrones de práctica de los endoscopistas, cuando se acercan a pacientes diagnosticados con lesiones colorrectales que requieren resección quirúrgica. Se evaluó el proceso de toma de decisiones para realizar una nueva endoscopia preoperatoria.RESULTADOS:Surgieron tres temas clave: 1) patrones de comunicación, 2) retroalimentación y 3) confianza. El análisis temático reveló que la pobre comunicación y la ambigua documentación aumentaron la probabilidad de realizar una nueva endoscopia preoperatoria. Las inconsistencias en las prácticas de tatuaje y la ubicación de las lesiones fueron factores importantes. Las experiencias pasadas negativas y los factores relacionados con la confianza interprofesional surgieron como contribuyentes clave para repetir la endoscopia preoperatoria.LIMITACIONES:La transferibilidad de los hallazgos a los sistemas de atención médica fuera de Canadá, puede ser limitada y requiere más estudios.CONCLUSIONES:Los informes endoscópicos subóptimos contribuyen a las brechas en la comunicación entre los endoscopistas. Además, la falta de retroalimentación consistente y la confianza mutua pueden aumentar la probabilidad de realizar una nueva endoscopia baja preoperatoria. Las prácticas inconsistentes de tatuaje, plantean preocupaciones importantes para la localización precisa de las lesiones intraoperatorias. El establecimiento de entornos de trabajo colaborativo a través de iniciativas educativas conjuntas pueden mejorar la comunicación y mitigar la repetición de procedimientos innecesarios. Estos resultados apoyan la necesidad de pautas estandarizadas e informes endoscópicos en el tratamiento de las lesiones colorrectales. Consulte Video Resumen en http://links.lww.com/DCR/B879 . (Traducción-Dr. Fidel Ruiz Healy ).
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Affiliation(s)
- Olivia Hershorn
- Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jason Park
- Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Harminder Singh
- Section of Gastroenterology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gayle J Restall
- Department of Occupational Therapy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kathleen M Clouston
- Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ashley S Vergis
- Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ramzi M Helewa
- Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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Chen MZ, Devan Nair H, Saboo A, Lee SCL, Gu X, Auckloo SMA, Tamang S, Chen SJ, Lowe RW, Strugnell N. A single centre audit: repeat pre-operative colonoscopy. ANZ J Surg 2022; 92:2571-2576. [PMID: 35642258 DOI: 10.1111/ans.17813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/03/2022] [Accepted: 05/07/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Repeat colonoscopy may be required for tumour localisation. The aim of the study is to explore the clinical settings it was used and benchmark the quality of initial colonoscopy against standardized guidelines for tumour localisation, tattooing and colonoscopy reporting amongst clinicians. METHODS A retrospective study from 2016 to 2021 has been performed on patients who underwent elective colorectal cancer resections at the Northern Hospital. Patient demographics, colonoscopic and operative details were retrieved from the Bi-National Colorectal Cancer Audit (BCCA) Registry database and hospital medical records. PRIMARY OUTCOMES changes in operative approach and delays to operation. SECONDARY OUTCOMES reasons for a repeat colonoscopy and complications from repeat colonoscopy. RESULTS A total of 339 patients were included in this study. 94 (28.6%) underwent a repeat colonoscopy. Re-scoping rate was 29.6% for surgeons, and 26.2% for non-operating endoscopists. Surgeons had a 5.9% localisation error rate, and non-operating endoscopist 6.95% (p = 0.673). Surgeons did not have a lower rate of repeat colonoscopy (p = 0.462). Repeat endoscopy was associated with a longer time to definitive operation (p < 0.001). No complications were associated with a repeat colonoscopy. CONCLUSION There was no difference in localisation error rates or repeat colonoscopy amongst surgeons (29.6%) and non-operating endoscopists (26.2%) (p = 0.462). This could be explained by the standardized endoscopy training in Australia governed by a common training board. Lack of tattooing at index colonoscopy and inadequate documentation often led to a repeat endoscopy, which was associated with a longer time to definitive operation. Standardized guidelines in tattooing of lesions and colonoscopy reporting should be implemented.
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Affiliation(s)
- Michelle Zhiyun Chen
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Hareshdeva Devan Nair
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Apoorva Saboo
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Sharon Chih Lin Lee
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Xinchen Gu
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | | | - Sandeep Tamang
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Sally Jiasi Chen
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Ryan William Lowe
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Neil Strugnell
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Calborean A, Macavei S, Mocan M, Ciuce C, Bintintan A, Cordos A, Pestean C, Chira R, Zarbo L, Barbu-Tudoran L, Dindelegan G, Nickel F, Mocan B, Surlin V, Bintintan V. Non-invasive laparoscopic detection of small tumors of the digestive tract using inductive sensors of proximity. Sci Rep 2022; 12:760. [PMID: 35031673 PMCID: PMC8760327 DOI: 10.1038/s41598-022-04822-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/17/2021] [Indexed: 11/18/2022] Open
Abstract
The precise location of gastric and colorectal tumors is of paramount importance for the oncological surgeon as it dictates the limits of resection and the extent of lymphadenectomy. However, this task proves sometimes to be very challenging, especially in the laparoscopic setting when the tumors are small, have a soft texture, and do not invade the serosa. In this view, our research team has developed a new instrument adapted to minimally-invasive surgery, and manipulated solely by the operating surgeon which has the potential to locate precisely tumors of the digestive tract. It consists of an inductive proximity sensor and an electronic block encapsulated into an autoclavable stainless-steel cage that works in tandem with an endoscopic hemostatic clip whose structure was modified to increase detectability. By scanning the serosal side of the colon or stomach, the instrument is capable to accurately pinpoint the location of the clip placed previously during diagnostic endoscopy on the normal bowel mucosa, adjacent to the tumor. In the current in-vivo experiments performed on large animals, the modified clips were transported without difficulties to the point of interest and attached to the mucosa of the bowel. Using a laparoscopic approach, the detection rate of this system reached 65% when the sensor scanned the bowel at a speed of 0.3 cm/s, and applying slight pressure on the serosa. This value increased to 95% when the sensor was guided directly on the point of clip attachment. The detection rate dropped sharply when the scanning speed exceeded 1 cm/s and when the sensor-clip distance exceeded the cut-off value of 3 mm. In conclusion, the proposed detection system demonstrated its potential to offer a swift and convenient solution for the digestive laparoscopic surgeons, however its detection range still needs to be improved to render it useful for the clinical setting.
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Affiliation(s)
- Adrian Calborean
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, Cluj-Napoca, Romania.
| | - Sergiu Macavei
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, Cluj-Napoca, Romania
| | - Mihaela Mocan
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Catalin Ciuce
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Adriana Bintintan
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Adrian Cordos
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Cosmin Pestean
- University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca, Calea Manastur Street No. 3-5, Cluj-Napoca, Romania
| | - Romeo Chira
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Liviu Zarbo
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, Cluj-Napoca, Romania
| | - Lucian Barbu-Tudoran
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, Cluj-Napoca, Romania
| | - George Dindelegan
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Felix Nickel
- Clinic for General, Visceral and Transplantation Surgery, University of Heidelberg, INF 110, Heidelberg, Germany
| | - Bogdan Mocan
- Technical University Cluj-Napoca, Memorandumului, Street No.28, Cluj-Napoca, Romania
| | - Valeriu Surlin
- University of Medicine and Pharmacy Craiova, Petru Rares Street No. 2, 700115, Craiova, Romania
| | - Vasile Bintintan
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
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Computed Tomography Colonography Angiography (CTC-A) prior to colectomy for cancer: A new tool for surgeons. J Visc Surg 2021; 159:136-143. [PMID: 34794900 DOI: 10.1016/j.jviscsurg.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The pre-operative work-up for non-metastatic colon cancer includes colonoscopy and thoraco-abdomino-pelvic computed tomography (CT) with intravenous (IV) contrast. Colonoscopic determination of the anatomical location of the tumor may be erroneous, particularly with a long redundant colon (dolichocolon), and the search for synchronous colon neoplasms is limited when the endoscope cannot traverse the tumor-bearing segment. While computed tomography colonography angiography (CTC-A) makes it possible to assess distant tumor metastasis, it remains limited for the assessment of loco-regional extension. CTC-A requires specific colonic preparation, controlled colonic insufflation with CO2, and an injection of IV contrast. CTC-A provides a 3-D view of the overall morphology of the colon and precisely localizes the site of the colonic tumor. Merging the images of the colon with those of mesenteric and colonic vessels provides a representation of anatomical vascular variations. This information could help the surgeon to better plan the colectomy. The use of two-dimensional images of CTC-A with sections perpendicular to the major axis of the tumor-bearing colonic segment can provide precise information on the degree of parietal extension and be useful in evaluating the value of neo-adjuvant chemotherapy.
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Tattooing or Metallic Clip Placement? A Review of the Outcome Surrounding Preoperative Localization Methods in Minimally Invasive Anterior Resection Performed at a Single Center. Surg Laparosc Endosc Percutan Tech 2021; 32:101-106. [PMID: 34653111 PMCID: PMC8812424 DOI: 10.1097/sle.0000000000001010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND For minimally invasive colorectal surgery, preoperative localization is a typical procedure. We here aimed to analyze compared 2 different localization methods in terms of short-term outcomes, like the operative outcome and postoperative complication rates based on real-world data. MATERIALS AND METHODS This was a retrospective analysis study conducted at a medical center. We enrolled patients who were presented with colonic tumor between January 1, 2016, and December 31, 2019, and they had undergone laparoscopic anterior resection in a single institution. Data included patient characteristics, operative outcome, length of hospital stay, and postoperative complications. RESULTS The preoperative localization group had a better resection margin (4 vs. 3 cm; P<0.001) and fewer procedures of intraoperative colonoscopy (4.67% vs. 18.22%; P=0.002). Lymph node harvest occurred more in patients with endoscopic tattooing procedures than with metallic clip procedures (25 vs. 20; P=0.031). No significant difference was found regarding postoperative complications and the length of hospital stay. CONCLUSIONS Preoperative localization in a laparoscopic anterior resection led to better surgical planning and resection margin. The metallic clip placement was helpful in the preoperative localization and setting. The endoscopic tattooing method had a larger lymph node harvest and with fewer intraoperative colonoscopy.
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Tatar C, Benlice C, Rencuzogullari A, Church J, Ozuner G, Liska D, Steele SR, Gorgun E. Intraoperative Colonoscopy During Colorectal Surgery Does Not Increase Postoperative Complications: An Assessment From the ACS-NSQIP Procedure-targeted Cohort. Surg Laparosc Endosc Percutan Tech 2021; 31:475-478. [PMID: 33449514 DOI: 10.1097/sle.0000000000000907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 11/04/2020] [Indexed: 11/26/2022]
Abstract
Intraoperative colonoscopy (IOC) is an adjunct in colorectal surgery to detect the location of the lesions and assessing anastomotic integrity. The authors aimed to evaluate the safety and feasibility and postoperative morbidity of IOC in left-sided colectomy patients for colorectal cancer. Patients undergoing elective left-sided colectomy without any proximal diversion for colorectal cancer between 2013 and 2016 were reviewed from the American College of Surgeons National Surgical Quality Improvement Program procedure-targeted database. Demographics, comorbidities, short-term outcomes, and postoperative morbidity of patients were evaluated. A total of 8811 patients were identified and IOC was performed for 1143 (12.97%) patients. There was no significant difference in postoperative complications between the IOC and non-IOC groups. Patients with IOC had shorter total hospital length of stay. The use of IOC does not adversely affect short-term outcomes after colorectal resections. Surgeons may utilize IOC liberally for left-sided colorectal resections.
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Affiliation(s)
- Cihad Tatar
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
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10
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Calborean A, Macavei S, Mocan M, Ciuce C, Cordos A, Bintintan A, Chira R, Pestean C, Pop O, Barbu-Tudoran L, Dindelegan G, Surlin V, Nickel F, Mocan B, Bintintan V. Laparoscopic compatible device incorporating inductive proximity sensors for precise detection of gastric and colorectal small tumors. Surg Oncol 2020; 35:504-514. [PMID: 33137657 DOI: 10.1016/j.suronc.2020.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022]
Abstract
The accurate localization of small tumors of the digestive tract is of paramount importance in surgical oncology because it dictates the limits of resection and the extent of lymph node dissection. In this view, we have designed and fabricated a highly efficient sensing laparoscopic instrument focused on precise non-invasive extralumenal intraoperative detection of small colorectal or gastric tumors. The equipment is fully adapted for laparoscopic surgery and consists of an inductive proximity sensor encapsulated into a watertight stainless-steel case that is connected to an electronic functional block dimensionally scaled-down by the desired form and size for optimal surgical manipulation. The sensor-case unit and the electronic block are coupled together using a modular system which allows disconnection of the latter and sterilization by autoclavation of the former, followed by swift plugging of the electronic block just before surgery in a sterile-controlled environment. The instrument works in tandem with a modified endoscopic hemostatic clip which is attached endoscopically, before surgery, in the mucosa proximal and distal to the tumor. By scanning the serosal side of the digestive organ during the laparoscopic surgical procedure, the detector senses the modified clip and thus pinpoints to the location of the tumor. Additional engineering of the standard endoscopic hemostatic clips by coating them with various combinations of metallic alloys of Cu and Zn was necessary to improve the detection range and sensitivity without compromising on their functionality. The clips were also covered with nanometric layers of Au to ensure their biocompatibility. The ex-vivo dry-lab experiments showed a satisfactory detection distance which was later confirmed in ex-vivo wet-lab experiments on animal organs and human surgical specimens.
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Affiliation(s)
- Adrian Calborean
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, 400293, Cluj-Napoca, Romania.
| | - Sergiu Macavei
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, 400293, Cluj-Napoca, Romania
| | - Mihaela Mocan
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Cătalin Ciuce
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Adrian Cordos
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Adriana Bintintan
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Romeo Chira
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Cosmin Pestean
- University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca, Calea Mănăştur Street No. 3-5, 400372, Cluj-Napoca, Romania
| | - Oana Pop
- University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca, Calea Mănăştur Street No. 3-5, 400372, Cluj-Napoca, Romania
| | - Lucian Barbu-Tudoran
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, 400293, Cluj-Napoca, Romania
| | - George Dindelegan
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Valeriu Surlin
- University of Medicine and Pharmacy Craiova, Petru Rare Street No.2, 200394, Craiova, Romania
| | - Felix Nickel
- University of Heidelberg, Clinic for General, Visceral and Transplantation Surgery, INF 110, 69120, Heidelberg, Germany
| | - Bogdan Mocan
- Technical University Cluj Napoca, Memorandumului Street No. 28, 400114, Cluj Napoca, Romania
| | - Vasile Bintintan
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
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11
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Hershorn O, Park J, Singh H, Clouston K, Vergis A, Helewa RM. Predictors and rates of prior endoscopic tattoo localization amongst individuals undergoing elective colorectal resections for benign and malignant lesions. Surg Endosc 2020; 35:5524-5530. [PMID: 33025255 DOI: 10.1007/s00464-020-08048-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/25/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Appropriate tattooing of suspicious lesions during colonoscopy is critical for surgical planning. However, variability exists in tattoo placement, technique, and reporting. Our aim is to determine the rates and predictors of tattoo placement, tattoo location in relation to the lesion, and localization accuracy during lower endoscopy for individuals undergoing elective colorectal resections. METHODS We performed a retrospective chart review on all patients undergoing elective colorectal resections for benign and malignant neoplasms between 2007 and 2017 at a high volume Canadian tertiary centre. Patient demographics, endoscopic, and tumour-related characteristics were collected. Multivariable logistic regression analysis was used to identify predictors of tattoo localization. RESULTS Of the 1062 patients identified, laparoscopic resection occurred in 59% of patients. 57% of patients underwent tattooing for tumour localization at index endoscopy. Tattoos were placed distal (27%), both proximal and distal (4%), and just proximal (2%) to the lesion. However, in the majority of cases the tattoo location was not documented (67%). On multivariate analysis, patients who had lesions located in the transverse colon (OR: 1.93, 95% CI 1.04-3.59), had surgery performed after 2010 (2011-2014: OR: 1.88, 95% CI 1.31-2.68; 2015-2017: OR: 2.87, 95% CI 1.93-4.26), underwent laparoscopic resections (OR: 1.69, 95% CI 1.22-2.33), and had their index endoscopy performed in an urban setting (OR: 5.92, 95% CI 3.23-10.87), were at higher odds of having a tattoo placed at index endoscopy. CONCLUSION Endoscopic tattoo placement and location in relation to the lesion varies widely, with reports containing suboptimal documentation. Lesion location and laparoscopic procedures were significant predictors of tattoo placement. This study highlights the need for standardized tattooing practices and reporting amongst endoscopists. One of the focus of quality improvement efforts should be educational initiatives for rural endoscopists.
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Affiliation(s)
- Olivia Hershorn
- Section of General Surgery, Department of Surgery, University of Manitoba, Tache Avenue, Z3049-409, Winnipeg, MB, R2H 2A6, Canada.
| | - Jason Park
- Section of General Surgery, Department of Surgery, University of Manitoba, Tache Avenue, Z3049-409, Winnipeg, MB, R2H 2A6, Canada
| | - Harminder Singh
- Section of Gastroenterology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Kathleen Clouston
- Section of General Surgery, Department of Surgery, University of Manitoba, Tache Avenue, Z3049-409, Winnipeg, MB, R2H 2A6, Canada
| | - Ashley Vergis
- Section of General Surgery, Department of Surgery, University of Manitoba, Tache Avenue, Z3049-409, Winnipeg, MB, R2H 2A6, Canada
| | - Ramzi M Helewa
- Section of General Surgery, Department of Surgery, University of Manitoba, Tache Avenue, Z3049-409, Winnipeg, MB, R2H 2A6, Canada.
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12
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Nahid M, Shrestha AK, Imtiaz MR, Basnyat PS. Endoscopic tattooing for colorectal lesions: impact on quality of care and patient outcomes. Ann R Coll Surg Engl 2020; 102:594-597. [PMID: 32538104 DOI: 10.1308/rcsann.2020.0104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The National Bowel Cancer Screening Programme guidelines advocate the use of endoscopic tattooing for suspected malignant lesions to assist identification and to facilitate laparoscopic resections. However, endoscopic tattooing practices are variable in endoscopic units, resulting in repeat endoscopy and delay in patient management. The aim of this study was to assess the adherence to tattoo protocol for significant colonic lesions at an endoscopy unit in a large district general hospital. MATERIALS AND METHODS Prospectively collected data were analysed for 252 patients with significant colonic lesions between January 2017 and December 2018. Data were collected through reviewing patient's notes, histopathology findings and endoscopy reports. Data on lesions, complications, number and site of tattoo placed, and any repeat endoscopy for a tattoo were collected. RESULTS Of the 252 patients, 88% (n = 222) had malignant and 12% (n = 30) had benign lesions. Only 58.7% (n = 148) of those patients who had colonoscopy had tattoo placement reported. Of these 148 cases, the report stated the distance of tattoo in relation to the lesion in only 46% (n = 68) of patients. Unfortunately, 14.3% (n = 36) of patients required repeat endoscopy to tattoo the lesions prior to surgery. CONCLUSIONS Our study highlights the lack of uniformity of tattoo practice among endoscopists. Despite the National Bowel Cancer Screening Programme guidelines, a significant proportion of colorectal lesions are still not tattooed during their first endoscopy. Some patients had to have repeat endoscopy just for the purpose of tattooing. Active involvement and participation of all endoscopists in the colorectal and the complex polyp multidisciplinary teams may help to improve the tattoo service.
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Affiliation(s)
- Mak Nahid
- William Harvey Hospital, Ashford, Kent, UK
| | | | - M R Imtiaz
- William Harvey Hospital, Ashford, Kent, UK
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13
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Liu ZH, Liu JW, Chan FS, Li MK, Fan JK. Intraoperative colonoscopy in laparoscopic colorectal surgery: A review of recent publications. Asian J Endosc Surg 2020; 13:19-24. [PMID: 30997741 DOI: 10.1111/ases.12704] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/11/2019] [Accepted: 02/28/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Laparoscopic colorectal resection is becoming the gold standard for treating colorectal cancers because it offers superior short-term and comparable long-time outcomes compared to open surgery. Intraoperative colonoscopy (IOC) is increasingly performed for tumor localization and mucosal assessment. The aim of this report was to review the safety and efficacy of IOC in laparoscopic colorectal surgery. METHOD A MEDLINE search of studies of IOC in laparoscopic colorectal surgery was performed. We focused on three aspects of IOC use: (i) IOC for intraoperative tumor localization; (ii) colonic irrigation and IOC for obstructive left-sided colorectal cancers; and (iii) IOC for assessing colorectal anastomosis. RESULTS During laparoscopic colorectal surgery, IOC enables accurate localization of early mucosal tumors, detection of lesions in the proximal unexamined colon for obstructive left-sided cancer, and visual assessment of anastomosis. Additionally, IOC allows for proper surgical resection, management of concomitant lesions, immediate maintenance of hemostasis, suture repair of leaks, and the creation of a protective stoma as necessary. CONCLUSIONS Intraoperative colonoscopy is beneficial in laparoscopic colorectal surgery. Experienced surgical endoscopists should be trained to safely perform IOC.
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Affiliation(s)
- Z H Liu
- Department of Surgery, The University Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - J W Liu
- Department of Surgery, The University Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Fion Sy Chan
- Department of Surgery, The University Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Surgery, The University of Hong Kong, HKSAR, China
| | | | - Joe Km Fan
- Department of Surgery, The University Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Surgery, The University of Hong Kong, HKSAR, China.,Asia Pacific Endo-Lap Surgery Group, HKSAR, China
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14
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Bințințan V, Calborean A, Mocan M, Macavei S, Cordoș A, Ciuce C, Bințințan A, Chira R, Nagy G, Surlin V, Timofte D, Nickel F, Mueller B, Dindelegan G, Ciuce C, Brad S, Murar M, Mocan B. New inductive proximity sensor platform for precise localization of small colorectal tumors. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 106:110146. [PMID: 31753407 DOI: 10.1016/j.msec.2019.110146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 08/21/2019] [Accepted: 08/29/2019] [Indexed: 11/15/2022]
Abstract
Location of small gastric or colorectal tumors during a laparoscopic procedure is often imprecise and can be misleading. There is a real need for a compatible and straightforward tool that can be used intraoperatively to help the surgeon in this regard. We emphasize in the present work on the fabrication of a new and innovative inductive proximity switch architecture, fully compatible with laparoscopic surgery and with direct application in precise localisation of bowel tumors. An electromagnetic detection probe optimized for laparoscopic surgery and preconditioned for sterilisation was designed and constructed. Various metallic markers designed to be attached to the gastrointestinal mucosa were used for detection by the probe, from standard endoscopic and laparoscopic haemostatic clips to other custom made tags. Experiments were performed in dry and wet-lab experimental laboratory environment using ex-vivo segments of calf's small bowel and colonic surgical specimens from human patients. The dry-lab detection range varied considerably depending on the metallic component of the tags, from 0.5 mm for the endoscopic hemostatic clip to 3.5 mm for the 0.9 mm thickness stainless-steel custom tags. The latter was actually detectable from the serosal side of the fresh colonic surgical specimens in 85% of the attempts if the scanned area was less than 150 cm2 and less than 2 mm of fat was interposed between the probe and the bowel. The newly designed system has the potential to discover metallic tags attached to the bowel mucosa for precise intraoperative laparoscopic location of digestive tumors. Further work is in progress to increase the sensitivity and detection range of the system in order to make it fully compatible with the clinical use.
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Affiliation(s)
- Vasile Bințințan
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012 Cluj-Napoca, Romania
| | - Adrian Calborean
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donat 67-103, 400293 Cluj-Napoca, Romania.
| | - Mihaela Mocan
- Technical University Cluj Napoca, Memorandumului Street No. 28, 400114 Cluj Napoca, Romania
| | - Sergiu Macavei
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donat 67-103, 400293 Cluj-Napoca, Romania
| | - Adrian Cordoș
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012 Cluj-Napoca, Romania
| | - Catalin Ciuce
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012 Cluj-Napoca, Romania
| | - Adriana Bințințan
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012 Cluj-Napoca, Romania
| | - Romeo Chira
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012 Cluj-Napoca, Romania
| | - Georgiana Nagy
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012 Cluj-Napoca, Romania
| | - Valeriu Surlin
- University of Medicine and Pharmacy Craiova, Petru Rares Street No 2, 200349 Craiova, Romania; University of Medicine and Pharmacy Iasi, Universitatii Street Nr.16, 700115, Iasi, Romania
| | - Dan Timofte
- University of Medicine and Pharmacy Iasi, Universitatii Street Nr.16, 700115, Iasi, Romania
| | - Felix Nickel
- University of Heidelberg, Clinic of Surgery, INF 110, 69120 Heidelberg, Germany
| | - Beat Mueller
- University of Heidelberg, Clinic of Surgery, INF 110, 69120 Heidelberg, Germany
| | - George Dindelegan
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012 Cluj-Napoca, Romania
| | - Constantin Ciuce
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012 Cluj-Napoca, Romania
| | - Stelian Brad
- Technical University Cluj Napoca, Memorandumului Street No. 28, 400114 Cluj Napoca, Romania
| | - Mircea Murar
- Technical University Cluj Napoca, Memorandumului Street No. 28, 400114 Cluj Napoca, Romania
| | - Bogdan Mocan
- Technical University Cluj Napoca, Memorandumului Street No. 28, 400114 Cluj Napoca, Romania
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15
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Maupoey Ibáñez J, Pàmies Guilabert J, Frasson M, Boscà Robledo A, Giner Segura F, García-Granero Ximénez E. Accuracy of CT colonography in the preoperative staging of colon cancer: a prospective study of 217 patients. Colorectal Dis 2019; 21:1151-1163. [PMID: 31161677 DOI: 10.1111/codi.14724] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 04/25/2019] [Indexed: 12/18/2022]
Abstract
AIM The purpose of the present study was to evaluate the accuracy of computed tomography colonography (CTC) in the preoperative localization and TN staging of colon cancer. CTC can be an effective technique for preoperative evaluation of colon cancer and could facilitate the selection of high-risk patients who may benefit from neoadjuvant chemotherapy. METHOD This was a prospective observational study conducted at a single tertiary-care centre. It involved 217 patients (225 tumours) who had colon cancer and underwent preoperative CTC and elective colectomy. The radiologist determined the TNM stage using postprocessing software with multiplanar images and virtual colonoscopy. The following criteria were analysed for every colon tumour: location, size and signs of direct colon wall invasion. The histopathological findings of the surgical colectomy specimens served as the reference standard for local staging. RESULTS CTC detected all tumours and achieved an exact location in 208 cases (92.4%). CTC findings changed the surgical plan in 31 patients (14.3%) following colonoscopy. The accuracy in differentiating T3/T4 vs T1/T2 tumours was 87.1%, with a sensitivity and specificity of 88.5% and 84.1%, respectively (kappa = 0.71). For high-risk tumours (T3 ≥ 5 mm and T4), CTC showed an accuracy, sensitivity and specificity of 82.7%, 86% and 80%, respectively (kappa = 0.65). The accuracy of N-stage evaluation was 69.3%, the sensitivity 74% and the specificity 67.1% (kappa = 0.37). CONCLUSION CTC provides accurate information for the assessment of tumour localization and T staging, allowing better surgical planning and also allows the selection of locally advanced tumours that may benefit from new treatments such as neoadjuvant chemotherapy.
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Affiliation(s)
- J Maupoey Ibáñez
- Department of General Surgery, Colorectal Unit, La Fe University and Polytechnic Hospital, University of Valencia, Valencia, Spain
| | - J Pàmies Guilabert
- Department of Radiology, La Fe University and Polytechnic Hospital, University of Valencia, Valencia, Spain
| | - M Frasson
- Department of General Surgery, Colorectal Unit, La Fe University and Polytechnic Hospital, University of Valencia, Valencia, Spain
| | - A Boscà Robledo
- Department of General Surgery, Colorectal Unit, La Fe University and Polytechnic Hospital, University of Valencia, Valencia, Spain
| | - F Giner Segura
- Department of Pathology, La Fe University and Polytechnic Hospital, University of Valencia, Valencia, Spain
| | - E García-Granero Ximénez
- Department of General Surgery, Colorectal Unit, La Fe University and Polytechnic Hospital, University of Valencia, Valencia, Spain
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Rex DK. The Appropriate Use and Techniques of Tattooing in the Colon. Gastroenterol Hepatol (N Y) 2018; 14:314-317. [PMID: 29991940 PMCID: PMC6034606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Douglas K Rex
- Director of Endoscopy Indiana University Hospital Professor of Medicine Division of Gastroenterology and Hepatology Indiana University School of Medicine Indianapolis, Indiana
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