CTC improves surgical management plans for patients with colorectal cancer

Preoperative CT colonography (CTC) findings can improve the surgical management plan for patients with occlusive colorectal cancer (CRC) and incomplete colonoscopy (IC), according to a new study published in the American Journal of Roentgenology.

Researchers sought to evaluate changes in preoperative surgical planning after CTC is performed for patients with CRC and IC.

“CT colonography, also known as virtual colonoscopy, has been recognized as an alternative approach in evaluating the entire colon after IC,” said lead author Natally Horvat, with Memorial Sloan Kettering Cancer Center in New York, and colleagues. “The increasing importance of CTC has been highlighted by its inclusion as a current CRC screening test option in screening guidelines issued by several national organizations, including the American Cancer Society, American College of Radiology, and U.S. Multi-Society Task Force, the American College of Gastroenterology, the European Society of Gastrointestinal Endoscopy and European Society of Gastrointestinal and Abdominal Radiology, and, most recently, in a recommendation issued by the U.S. Preventive Services Task Force in 2016.”

The researchers studied 65 patients with occlusive CRC who underwent CTC after IC. The scans and reports were reviewed by abdominal radiologists.

The results showed CTC contributed to a change in the initial surgical plan of the surgeon for more than 21 percent of patients. In 14 patients, there was detection of five synchronous proximal colon polyps, two imprecise CRC locations, one case of proximal colon ischemia and one instance of tumor infiltration of the bladder.

“All of these preoperative CTC findings proximal to the occlusive tumor were subsequently confirmed and justified the change in surgical management plans,” the authors wrote. “However, preoperative CTC did not detect seven proximal synchronous colon polyps, none of which were subsequently found to be advanced adenomas on pathologic analysis. On the basis of per-person and per-polyp analysis, we found overall sensitivities of 88.9 percent and 81.1 percent, respectively.”

The most common reason for changing the surgical management plan was detection of proximal synchronous neoplasia, including polyps in the colon or cancer and appendiceal neuroendocrine tumor which accounted for 71 percent of the number of cases with a revised surgical management plan.

“Our observations suggest that CTC plays an important role in the preoperative evaluation of the proximal colon in patients with occlusive CRC, by accessing approximately 90 percent of the colon segments, which were not evaluable by conventional colonoscopy,” the authors concluded.