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CT prognostic signs of postoperative complications in emergency surgery for acute obstructive colonic cancer

  • Abdominal Radiology
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

To identify CT prognostic signs of poor outcomes in acute obstructive colonic cancer (AOCC).

Methods

Demographic, clinical, laboratory, radiological and surgical data of 65 consecutive patients with AOCC who underwent emergency surgery were analyzed. CT exams were reviewed to assess diameters of cecum, ascending, transverse, descending, and sigmoid proximal to the tumor; colon segments’ CD/L1-VD ratios, continence of the ileocecal valve, small bowel overdistension, presence of small bowel feces sign and cecal pneumatosis. Post Operative complications (PO), according to the Clavien–Dindo classification, were analyzed.

Results

Gender, age and location of the tumor were not predictive factors of complications. Among laboratory exams, CRP was the most important predictive value of PO (OR 8.23). A cecum distension ≥ 9 cm represented the critical diameter beyond which perforation and cecal necrosis were found at surgery. Cecal pneumatosis at CT was correlated with cecal necrosis at surgery in < 50% of patients. Pre-operative transverse colon CD/L1-VD ratio ≥ 1.43 and descending colon CD/L1-VD ratio ≥ 1.31 were associated with the development of PO (grade ≥ III-V). PO (grade ≥ III-V) occurred in 18/65 patients.

Conclusion

Postoperative complications in emergency surgery of AOCC were not related to the age, sex and tumor’s location. Preoperative PCR values (≥ 2.17) predict the development of postoperative complications. CT resulted a valid diagnostic tool to identify patients at higher risk of complications: a CD/L1-VD ratios with cut-off values of 1.43 (transverse) and 1.31 (descending) predicted major complications (grade ≥ III-V) and a cecum distension ≥ 9 cm represented the critical diameter beyond which perforation occurred in > 84% of patients.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy

    Filomena Pezzullo, Ylenia Mandato, Carlo Liguori, Giulia Lassandro, Fabio Tamburro & Stefania Tamburrini

  2. Division of Radiology, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy

    Rosita Comune

  3. Department of Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy

    Raffaelle D’Avino

  4. Department of Emergency Radiology, San Camillo Forlanini Hospital, Rome, Italy

    Michele Galluzzo

  5. Department of Medicine, Surgery and Pharmacy, University of Sassari, Piazza Università, Sassari, Italy

    Mariano Scaglione

  6. Department of Radiology, James Cook University Hospital, Middlesbrough, UK

    Mariano Scaglione

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  1. Filomena Pezzullo
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  2. Rosita Comune
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  3. Raffaelle D’Avino
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  10. Stefania Tamburrini
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Correspondence to Stefania Tamburrini.

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The authors declare that they have no known competing finacial interests or personal relationship that could have appeared to influence the work reported in this paper.

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The study was conducted in accordance with the Declaration of Helsinki and  the local Institutional review board approved the observational retrospective study (2022030).

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Pezzullo, F., Comune, R., D’Avino, R. et al. CT prognostic signs of postoperative complications in emergency surgery for acute obstructive colonic cancer. Radiol med 129, 525–535 (2024). https://doi.org/10.1007/s11547-024-01778-y

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  • DOI: https://doi.org/10.1007/s11547-024-01778-y

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