Discussion
colorectal cancer, tumors, serosa-negative lesion, tumor
COLORECTAL CANCER, TUMOR, PNEUMOPERITONEUM, TUMORS, SPILLAGE
In recent years, early detection rate of early colorectal cancer is gradually increasing. Localization of such small, serosa-negative lesion is an important issue particularly when the surgery is performed through laparoscopy typically compromises tactile feedback [Colonoscopy, endoscopic tattooing with clip or staining agent, and intraoperative colonoscopy can be applied in the appropriate clinical situation to localize colonic lesions. Measurement of the distance from the anus by colonoscopic distancing alone has proven to be an inadequate option in most cases because of colonic redundancy which may cause looping of the scope and increase the distance [India ink is the most widely used material for preoperative tattooing and can persist in tissues in a long time [Intraoperative colonoscopy is another precise method; however, it is a somewhat complex procedure that requires an experienced endoscopist and specific instruments in the operating room. Pneumoperitoneum during laparoscopy can reduce visibility of colonoscopy and bowel distension during localization may impair the operative field for the surgeon [Autologous blood was first reported by Korean researchers in 2014 [The autologous blood tattooing may have disadvantages. The autologous venous blood for tattooing was sampled after identification of the lesion by endoscopy and not prepared to prevent coagulation. If the interval between sampling and injecting is too long, the blood may coagulate. Like other tattooing techniques, intraperitoneal spillage with autologous blood may create difficulty in identifying the tumor and may distort the anatomical tissue planes making laparoscopic dissection more difficult. It was reported that intraperitoneal spillage of tattooing blood results in less staining of the operation field [India ink is the most widely used material for preoperative tattooing worldwide. We understand trial without India ink is one limitation. Because commercially available autoclave sterilized India ink has not been approved by our hospital right now, we could not conduct a randomized controlled study with India ink. We will compare the autologous blood tattooing with intraoperative endoscopy, which can be candidate method if invisibility after tattooing with India ink in previous studies and ensure proper tumor localization. We also want to perform a trial with India ink with the approve for using the agent in our hospital or cooperate with other hospitals to carry out multi-center research in the future. The current proposed randomized trial therefore aims to evaluate the accuracy and safety of autogenous blood marker localization in laparoscopic radical resection for colorectal cancer. If our research hypothesis is statistically proved, the rational introduction of autologous blood tattooing in preoperative colonoscopy can help improve identification of the location of tumors for laparoscopic colorectal cancer surgery, performing an optimal resection, and minimizing unnecessary resections of normal tissues, thereby improving the patient’s quality of life. Our research data will also provide high quality clinical evidence and data support for the conduction of multicenter phase III clinical trials.