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  • Preoperative endoscopic tattooing technique improved lymph node retrieval in rectal cancer patients receiving neoadjuvant concurrent chemoradiotherapy

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Original research
Preoperative endoscopic tattooing technique improved lymph node retrieval in rectal cancer patients receiving neoadjuvant concurrent chemoradiotherapy
  1. Yi-Ting Chen1,2,3,
  2. Jaw-Yuan Wang3,4,5,6,7,8,
  3. Jiunn-Wei Wang9,10,
  4. Chee-Yin Chai1,2,3,4,11
  1. 1 Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  2. 2 Department of Pathology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  3. 3 Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  4. 4 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  5. 5 Division of Gastroenterology and General Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  6. 6 Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  7. 7 Center of Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan
  8. 8 Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Kaohsiung, Taiwan
  9. 9 Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
  10. 10 Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  11. 11 Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
  1. Correspondence to Dr Chee-Yin Chai, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; ccjtsai{at}yahoo.com

Abstract

Aims To describe the clinical utility of lymph node retrieval and prognostic value of tattooing in rectal cancer (RC) patients undergoing neoadjuvant concurrent chemoradiotherapy (CCRT).

Methods A total 97 RC patients underwent preoperative CCRT, and 38 patients had preoperative endoscopic tattooing. Surgical intervention was performed after CCRT and the specimens were sampled as standard protocol in all patients. Other clinicopathological parameters correlated with lymph node retrieval status were also analysed.

Results Fifteen patients (39.5%) of 38 RC patients in the tattooing group (TG) had adequate lymph node retrieval (>12) compared with 12 (20.3%) of 59 in the non-tattooing group. Higher lymph node retrieval rate was noted in the TG (p=0.04). In multivariable analysis, it showed tattooing was an independent predictive factor for higher lymph node retrieval in RC patients after CCRT (p=0.024) by logistic regression modelling. Besides histological grade, positive lymphovascular invasion, presence of lymph node metastasis, poor CCRT response and advanced pathological stage, inadequate lymph node retrieval was significantly associated with poor survival (all p<0.05) by Kaplan-Meier analysis. In multivariable analyses, the results revealed that lymph node retrieval (p=0.005), pathological stage (p=0.001) and tumour progression grade (p=0.02) were independent prognostic markers in RC patients receiving CCRT.

Conclusion Preoperative endoscopic tattooing is a useful technique for RC patient receiving neoadjuvant CCRT. It can improve lymph node retrieval and provide an adequate diagnosis for proper treatment and prognosis.

  • lymph node retrieval
  • endoscopic tattooing
  • rectal cancer
  • neoadjuvant concurrent chemoradiotherapy

https://doi.org/10.1136/jclinpath-2019-206240

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    Footnotes

    • Handling editor Runjan Chetty.

    • Contributors Y-TC: idea creation, experiment processing and manuscript writing. J-WW: data collection and data analysis. J-YW: reviewing clinical data C-YC: idea creation, study design and revising manuscript.

    • Funding This study was supported by a grant from the Kaohsiung Medical University Hospital (KMUH106-6T10), and the research support scheme of the Ministry of Science and Technology, Taiwan (MOST 107-2320-B-037-018).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.