| Background:Colorectal cancer is one of the most common gastrointestinal malignancies,while most colorectal carcinoma patients have no chance of surgery when diagnosed.There are few studies on the preoperative tumor localization after neoadjuvant therapy and the precise evaluation of therapeutic effects after chemotherapy and(or)radiotherapy of advanced colorectal cancer(ACRC),and the application of endoscopic tattooing as an intestinal location and evaluation of therapeutic effects were even less.A prospective case-control study was conducted to investigate the role of endoscopic tattooing in the precise treatment of ACRC in our study.Objective: The aim of this study was to compare the accuracy of measuring lesion and evaluating the therapeutic effects of endoscopic tattooing after chemoradiotherapy of ACRC,and compare effects of endoscopic tattooing in surgical resection after neoadjuvant therapy of ACRC.Methods: One hundred and twenty patients diagnosed with ACRC in Fuzhou General Hospital from January 1,2016 through December 30,2017 were randomly divided into tattooing group(Group T)and non-tattooing group(Group C)with 60 cases respectively.Endoscopic tattooing with carbon nanoparticles 1cm away from the lesion were underwent 1-7 days before chemoradiotherapy.All colon cancer were underwent the chemotherapy with Cape OX.All rectal cancer were underwent chemoradiotherapy.The radiotherapy was a traditional segmentation(long-range)program and the chemotherapy was an oral Capecitabine during radiation.Endoscopy,abdomen CT,MRI and blood CEA were reassessed after 8 weeks of treatment.Then compared the lesion size and evaluated the therapeutic effects.Patients who had operative chance would have surgical operation 6 weeks after chemoradiotherapy,the following parameters were compared:identifyication time,operation time,blood loss and distance from lesion to operation distal margin;the rate of first positive margin and the rate of anal sphincter preservation were compared additional in rectal carcinoma.Chemotherapy would be alternatived in patients who had no operative chance when tumor advanced.and patients with SD or above would continue the current chemotherapy.Results: One hundred and seventeen patients were involved in this study,including 59 cases in group T and 58 cases in group C.Adverse reactions of chemoradiotherapy were mild.No signs of fever,abdominal pain and blood in the faeces with tattooing were found and a clear and well-defined black plaque with no abscesses and exudations was seen on the tattooing mucosa and serosa in group T.Combined with MRI,CT,blood CEA and other indicators,77 patients(T1+C1)were operated 8 weeks later,including 39 cases in group T1 and 38 cases in group C1.Significant differences favoring tatooing were found with regard to identification time(3.39±1.42 min vs.11.80±3.44 min,p<0.001),operation time(155.66±44.45 min vs.177.18±30.17 min,p=0.015),blood loss(101.26±36.67 ml vs.120.23±38.20 min,p=0.029),distance from lesion to operation distal margin(3.72±1.00 cm vs.4.61±1.67 cm,p=0.034).The rate of first positive resection margin(0% vs.9.09%,p=0.223)and the rate of anal sphincter preservation(66.67% vs.45.45%,p=0.234)in group T1 were higher than that in group C1,while there was no statistical difference in comparison between two groups.Almost forty patients who had no operative chance(T2+C2),5 patients in group T2 and 2 patients in group C2 were found to have tumor progression and changed following chemotherapy.Then therapeutic effects would be evaluated half year later,1 patients with CR and 8 patients with PR in group T2;CR 0 and PR 6 in group C2 were found.Differences favoring tatooing were found with regard to(PR+CR)rate(45.00% vs.30.00%,p=0.514).Conclusion: Considering the more rapid and accurate identification of tuomor,we prospect that endoscopic tattooing as a promising agent in assisting the evaluation of chemoradiotherapy efficacy and identifying the ACRC lesion. |
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