J Minim Invasive Surg.  2025 Mar;28(1):19-24. 10.7602/jmis.2025.28.1.19.

Accuracy evaluation of preoperative indocyanine green tattooing and intraoperative colonoscopy in determining surgical resection margins for left-sided colorectal cancer: a retrospective study in Korea

• Park BS
• Cho SH
• Son GM
• Kim HS
• Jang JO
• Ryu DG
• Kim SJ
• Park SB
• Kim HW

• KMID: 2565901
• DOI: http://doi.org/10.7602/jmis.2025.28.1.19

Abstract

Purpose
We aimed to evaluate the precision of preoperative colonoscopic tattooing and intraoperative colonoscopic tumor localization in determining distal surgical margins for leftsided colorectal cancer surgery.
Methods
This retrospective study included 30 patients who underwent laparoscopic colorectal surgery, preoperative colonoscopic tattooing, and intraoperative colonoscopic localization for colorectal cancer at our center between July 2020 and March 2024. Clinical data were collected, and the precision of these methods was assessed by measuring the differences between the target resection margin and the actual pathological resection margin.
Results
In four patient cases, the indocyanine green tattoo was not visible in the laparoscopic surgical field. The average stained length of the tattoo was 2.89 cm, with a mean distance of 1.18 cm between the low margin of the tattoo and the cancer. The difference between the target distal resection margin by intraoperative colonoscopic localization and the actual pathological resection margin was 0.88 cm. No complications related to the intraoperative colonoscopy were observed.
Conclusion
Preoperative tattooing showed limitations, such as spreading and occasional invisibility. Intraoperative colonoscopic localization proved to be an effective method for achieving more precise distal surgical margins in left-sided colorectal cancer surgery.

Keyword

Colorectal neoplasms; Intraoperative colonoscopy; Indocyanine green; Margins of excision