0
Correspondence |

Routine or Selective Endoscopic Tattooing in Colon Resection for Cancer

Tetsuji Fujita, MD
Arch Surg. 2011;146(2):239. doi:10.1001/archsurg.2010.320.
Text Size: A A A
Published online

Extract

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.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

February 1, 2011
Richard C. Thirlby, MD
Arch Surg. 2011;146(2):239-240. doi:10.1001/archsurg.2010.321.
CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination
Make the Diagnosis: Cancer, Family History

The Rational Clinical Examination
Original Article: Does This Patient Have a Family History of Cancer?

brightcove.createExperiences();