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Contrast-enhanced abdominal computed tomography to evaluate anastomotic integrity before ileostomy closure in postoperative colorectal cancer patients

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Abstract

Purpose

To investigate the usefulness of contrast-enhanced abdominal computed tomography (CECT) to predict clinically significant anastomotic leakage (CSAL) in patients who received colorectal cancer surgery with diverting ileostomy.

Methods

In this retrospective cohort study, patients who underwent colorectal cancer surgery with diverting ileostomy from January 2014 to May 2018 and postoperative CECT were included. The performance of significant CECT features, identified using multivariable logistic regression, to predict CSAL was calculated. In subgroup analysis, the areas under the receiver operating characteristic curve (AUROCs) were compared between CECT and water-soluble contrast enema (WSCE) using DeLong’s method.

Results

Of 325 patients (median age, 58 years; 213 men), CECT was routinely performed to evaluate cancer status in 307 (94.5%), and CSAL was observed in 28 (8.6%). After multivariable adjustment, anastomotic mural defect (odds ratio [OR] 5.24; 95% confidence interval [CI] 1.77–15.51; p = 0.003), perianastomotic air (OR 7.28; 95% CI 1.82–29.17; p = 0.007) and ischemic colitis (OR 3.30; 95% CI 1.13–9.61; p = 0.029) were significantly associated with CSAL. The sensitivity, specificity, accuracy, and positive and negative predictive values of significant CECT features were 60.7%, 88.2%, 85.9%, 32.7%, and 96.0%, respectively. In subgroup analysis of 144 patients, the AUROC using significant CECT features (optimal sensitivity/specificity, 50.0%/90.4%) was comparable to that using WSCE (optimal sensitivity/specificity, 12.5%/97.8%) to predict CSAL (0.704 vs. 0.552, p = 0.085).

Conclusion

CECT performed after colorectal cancer surgery may be useful to assess anastomotic integrity before ileostomy closure, especially to negatively predict CSAL. In the presence of anastomotic mural defect, perianastomotic air, or ischemic colitis, WSCE may be recommended to exclude CSAL.

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Availability of data and materials

The datasets generated during the current study are available from the corresponding author on reasonable request.

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Funding

No funds, grants, or other support was received.

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Authors and Affiliations

  1. Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Yeun-Yoon Kim, Nieun Seo & Joon Seok Lim

  2. Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Kang Young Lee & Nam Kyu Kim

Authors
  1. Yeun-Yoon Kim
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  2. Nieun Seo
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  3. Kang Young Lee
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  4. Nam Kyu Kim
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Contributions

Y-YK: Data Curation, Investigation, Formal analysis, Writing—Original Draft, Visualization. NS: Investigation, Writing—Review & Editing. KYL: Investigation, Writing—Review & Editing. NKK: Investigation, Writing—Review & Editing. JSL: Conceptualization, Methodology, Investigation, Writing—Review & Editing.

Corresponding author

Correspondence to Joon Seok Lim.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This retrospective study was approved by the Institutional Review Board of Severance Hospital.

Informed consent

The requirement for informed consent was waived because the study involved a retrospective review of medical records and images.

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Kim, YY., Seo, N., Lee, K.Y. et al. Contrast-enhanced abdominal computed tomography to evaluate anastomotic integrity before ileostomy closure in postoperative colorectal cancer patients. Abdom Radiol 46, 4130–4137 (2021). https://doi.org/10.1007/s00261-021-03118-4

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  • DOI: https://doi.org/10.1007/s00261-021-03118-4

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