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Correspondence
February 2011

Routine or Selective Endoscopic Tattooing in Colon Resection for Cancer

Author Affiliations

Author Affiliation: Department of Surgery, Jikei University of School of Medicine, Tokyo, Japan.

Arch Surg. 2011;146(2):239. doi:10.1001/archsurg.2010.320

Because the use of preoperative colonoscopic tattooing increased the rate of surgical specimens meeting the benchmark of 12 lymph nodes in their cohort (from 72.3% to 87.1%), Dawson and colleagues1 advocate routine tattooing before colon resection for cancer. Endoscopic tattooing helps to identify small colonic lesions, especially in laparoscopic surgery, although intraperitoneal spillage of ink is not uncommon, and rare complications such as peritonitis and abscess formation have been reported.2 Given that 92% of patients with colon cancer in the National Comprehensive Cancer Network centers and 58% of patients with colon cancer in a US population–based sample have their disease staged with an adequate nodal evaluation,3 surgeons' efforts to accomplish a systematic lymphadenectomy and pathologists' efforts to vigorously search the specimen for small nodes are deemed to be the standard methods for adequate lymph node harvesting. However, there appear to be some factors responsible for the lymph node count that are outside the control of the surgeon or pathologist, such as the tumor site and the tumor stage.3,4 The use of endoscopic tattooing may increase the number of lymph nodes harvested and may detect hidden positive nodes in clinically node-negative cancers, whereas we still encounter patients with many visible nodes in the vicinity of the tumor or along the vessels in the colonic mesentery on preoperative computed tomography scans. In such cases, the benefit of tattooing is little and the risk of complications associated with repeated colonoscopy for tattooing is increased if the patient is referred to us with a confirmed pathologic diagnosis of adenocarcinoma of the colon.

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