Robbie Sparks, Dr, Ronan Cahill. Mater Misericordiae University Hospital
Background: Precise preoperative localisation of colonic cancer is a prerequisite for correct oncological resection. Effective endoscopic lesional tattoo is vital for small, radiologically unseen tumors planned for laparoscopic resection but its practice may be imperfect.
Methods: Retrospective review of consecutive patients with preoperative endoscopic lesional tattoo who underwent laparoscopic colonic resection identified from our prospectively-maintained cancer database with supplementary clinical chart and radiological, histological, endoscopic and theatre database/logbook interrogation.
Results: 169 patients (95 males, mean age 68 years, median BMI 27.8 kg/m2, 77 left sided lesions, 36 screen detected, 21 benign polyps, 23% conversion rate). In 104 operations (60%) tattoo visibility was documented with tattoo absence noted in 9 (8.5%) although tattoo was identifiable in the pathological specimen in four. In those with “missing tattoos”, six of the lesions were radiologically occult and in three the tumor was found in a different colonic segment then had been judged at colonoscopy. Four patients had on-table colonoscopy and five were converted to laparotomy (55% conversion rate, p<0.005). Mean postoperative length of stay was 15.5 (range 4-38) days. One patient’s segmental resection contained only benign pathology requiring a second operation to remove the cancer. On univariate analysis, time between endoscopy and surgery (but not patient age, gender, BMI, endoscopist or surgeon seniority, tumor size or location) was significantly associated with absence of tattoo intraoperatively (p=0.006).
Conclusion: Recording related to tattoo is variable but definite lack of gross tattoo visualisation significantly impacts the procedure. The mechanism of tattoo absence is multifactorial needing careful consideration but solvable.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88192
Program Number: P254
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster