Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Aug;6(3):210-214.
doi: 10.1093/gastro/goy003. Epub 2018 Feb 12.

The added clinical value of performing CT colonography in patients with obstructing colorectal carcinoma

Tom Offermans  1 , F Jeroen Vogelaar  2 , Michel Aquarius  3 , Maryska L G Janssen-Heijnen  4   5 , Petra C G Simons  1
Affiliations

The added clinical value of performing CT colonography in patients with obstructing colorectal carcinoma

Tom Offermans et al. Gastroenterol Rep (Oxf). 2018 Aug.

Abstract

Background: A small percentage of incomplete optical colonoscopies (OCs) are the result of an obstructing tumor. According to current guidelines, CT colonography (CTC) is performed to prevent missing a synchronous tumor. The aim of this study was to evaluate how frequently a synchronous tumor was found on CTC and how often this led to a change in the surgical plan.

Methods: In this retrospective study, a total of 267 patients underwent CTC after an incomplete OC as a result of an obstructing colorectal carcinoma (CRC). Among them, 210 patients undergoing surgery met the inclusion criteria and were included in the analysis. The OC report, CTC report and surgical report of these patients were retrospectively evaluated for the presence of synchronous tumors using surgery and post-operative colonoscopy as the gold standard.

Results: Six of the 210 patients (2.9%) showed signs of a synchronous CRC proximal to the obstructing tumor on CTC. In three of these patients, a synchronous CRC was confirmed during surgery. All these tumors caused a change in the surgical plan. Three out of the six tumors found on CTC were found to be large, non-malignant polyps. All these polyps were located in the same segment as the obstructing tumor and therefore did not alter the surgical plan.

Conclusion: In patients with obstructing CRC, the frequency of synchronous CRCs proximal to this lesion is low. Performing a CTC leads to a change in surgical plan based on the presence of these synchronous tumors in 1.4% of the cases. CTC should be employed as a one-stop shop in patients with an obstructing CRC.

Keywords: CT colonography; colorectal carcinoma; optical colonoscopy; pre-operative evaluation; synchronous tumor.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
A patient who underwent optical colonoscopy was found to have an obstructing T4 tumor in the sigmoid colon. A CT colonography that was performed to rule out synchronous tumors proximal to the obstructing tumor showed a synchronous tumor in the hepatic flexure. Based on this information, a subtotal colectomy was performed. Surgery confirmed the presence of a synchronous tumor in the hepatic flexure.
See this image and copyright information in PMC

References

    1. GLOBACAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. http://globocan.iarc.fr (21 April 2017, date last accessed).
    1. Shah HA, Paszat LF, Saskin R. et al. Factors associated with incomplete colonoscopy: a population-based study. Gastroenterology 2007;132:2297–303. - PubMed
    1. Aslinia F, Uradomo L, Steele A. et al. Quality assessment of colonoscopic cecal intubation: an analysis of 6 years of continuous practice at a university hospital. Am J Gastroenterol 2006;101:721–31. - PubMed
    1. Latournerie M, Jooste V, Cottet V. et al. Epidemiology and prognosis of synchronous colorectal cancers. Br J Surg 2008;95:1528–33. - PubMed
    1. Mulder SA, Kranse R, Damhuis RA. et al. Prevalence and prognosis of synchronous colorectal cancer: a Dutch population-based study. Cancer Epidemiol 2011;35:442–7. - PubMed