Limited clinical value of CT-colonography in obstructive colorectal cancer

Huisman, J.F. (2016) Limited clinical value of CT-colonography in obstructive colorectal cancer. thesis, Medicine.

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Abstract

Background In patients with obstructive colorectal cancer (CRC), visualisation of the entire colon prior to surgery is recommended to exclude synchronous tumors. Therefore, most centers combine CT- colonography (CTC) with the staging CT scan. Aims of our study were to evaluate the yield and clinical implications of CTC in these patients. Methods In this multicenter study, patients with obstructive CRC that underwent CTC and subsequent surgery between April 2013 and January 2016 were included. The outcome of the CTC, its influence on the surgical treatment plan as decided by a multidisciplinary team and the final pathology report were evaluated. Results 171 patients with obstructive CRC were included. Ten (5.8%) synchronous cancers proximal to the obstructive tumor were suspected with CTC. In four of ten patients the CTC did not changed the primary surgical plan because the tumor was located within the scheduled resection (right sided (extended) hemicolectomy (n=3), left sided hemicolectomy (n=1)). In 6 of 10 patients, the outcome of CTC changed the surgical treatment plan. In 3 of them the synchronous tumor was also visible on the staging CT. They underwent an extended resection and the presence of the tumors was confirmed by histology (T3 tumors (n=2), colon metastasis of an endometrial carcinoma (n=1). In one of the six patients the synchronous tumor was a T2 tumor. In the other 2 patients, the result of CTC was false positive which led to an unnecessary extended resection in one patient. In the other patient only one tumor was manifest during surgery and the surgeon decided not to perform an extended resection. Postoperative colonoscopy did not reveal a synchronous tumor. Conclusion The yield of CTC was relatively low (8/171, 4.7%). In only four patients (2.3%) CTC correctly changed the primary surgical plan, but in three of these cases the tumor was also visible on the staging CT- scan. Therefore, the clinical value of CTC in obstructive CRC appears to be limited. Accepted for oral presentation during the Spring meeting of the Dutch Society of Gastroenterology and Hepatology, Veldhoven, the Netherlands, March 17th & 18th

Item Type:	Thesis (Thesis)
Supervisor name:	Vos tot Nederveen Cappel, W.H. de MD-PhD and Department of Gastroenterology and Hepatology and Isala Hospital, Zwolle and The Netherlands
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:00
Last Modified:	25 Jun 2020 11:00
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2067

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