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Impact of contrast-enhanced computed tomography colonography on laparoscopic surgical planning of colorectal cancer

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Abstract

Aim

To evaluate the impact of contrast-enhanced computed tomography colonography (CE-CTC) on laparoscopic surgery planning in patient with stenosing colorectal cancer.

Materials and methods

Sixty-nine patients with endoscopically proven colorectal cancer underwent CE-CTC, after incomplete conventional colonoscopy. Two experienced radiologists evaluated site, length, and TNM staging of colorectal cancers on three-dimensional double contrast enema-like views, 2D axial and multiplanar reconstructions. All the patients underwent colorectal resection and surgery bulletin, pathology of surgical specimens, and radiological follow-up at about 8 months were used as reference standard.

Results

The detection rate of colorectal cancer was 100 % (75/75); CE-CTC allowed for a diagnosis of a synchronous colorectal cancer in five patients (7 %). CE-CTC correctly judged the site of the lesions in all the cases; clinically significant localization errors at conventional colonoscopy were noted in 3 out of 69 patients (4 %). Additional colonic polyps greater than 6 mm in diameter were found in 21 out of 69 patients (30 %); in two patients (3 %) the surgeon performed an enlarged colectomy to include synchronous polyps proximal to colorectal cancer. Sensitivity, specificity, PPV, NPV, and accuracy were for T1–T2 vs. T3–T4: 96 %, 71 %, 92 %, 87 %, and 91 %, respectively; for N: 94 %, 42 %, 64 %, 86 %, and 70 %; for M: 100 %, 100 %, 83 %, 100 %, and 97 %. There were no complications associated with CE-CTC.

Conclusion

Information given by CE-CTC concerning colorectal cancer location and synchronous colonic cancers and polyps changed the laparoscopic surgical strategy in almost 14 % of patients.

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Acknowledgments

The authors acknowledge Raffaella Azzeroni [Medical Physicist], for her collaboration.

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Authors and Affiliations

  1. Unità Operativa di Radiologia Diagnostica e Interventistica, Azienda Ospedaliera San Paolo, Via A di Rudinì 8, 20142, Milan, Italy

    Nicola Flor, Silvia Tresoldi & Simone Soldi

  2. Servizio di Chirurgia Generale, Azienda Ospedaliera San Paolo, Via A di Rudinì 8, 20142, Milan, Italy

    Andrea Pisani Ceretti

  3. Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy

    Miriam Mezzanzanica, Paolo Rigamonti & Mauro Peri

  4. Servizio di Endoscopia Digestiva, Azienda Ospedaliera San Paolo, Via A di Rudinì 8, 20142, Milan, Italy

    Benedetto Mangiavillano

  5. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy

    Francesco Sardanelli

  6. Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via A. di Rudinì 8, 20142, Milan, Italy

    Gian Paolo Cornalba

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  1. Nicola Flor
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  2. Andrea Pisani Ceretti
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Correspondence to Nicola Flor.

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Flor, N., Ceretti, A.P., Mezzanzanica, M. et al. Impact of contrast-enhanced computed tomography colonography on laparoscopic surgical planning of colorectal cancer. Abdom Imaging 38, 1024–1032 (2013). https://doi.org/10.1007/s00261-013-9996-5

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  • DOI: https://doi.org/10.1007/s00261-013-9996-5

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