Claes K, Beckers R, Heindryckx E, Kyle-Leinhase I, Pletinckx P, Claeys D, Muysoms F
Department of Surgery, AZ Maria Middelares, Kortrijksesteenweg 1026, 9000, Ghent, Belgium.
Hernia. 2014;18(6):797-802. doi: 10.1007/s10029-014-1214-z. Epub 2014 Jan 21.
Incisional hernia (IH) is the most frequent complication after colorectal carcinoma (CRC) resection. The incidence depends on the method of follow-up, where ultrasound yields a significant number of additional hernias compared to clinical examination alone. Not many studies have evaluated the value of computed tomography (CT) to diagnose IH.
The CorreCT study is a retrospective cohort study of IH after CRC surgery by clinical examination and by CT, as reported in the medical files. Additional independent reviewing of all CTs by two radiologists was performed.
From the oncological database (2004-2008) of the hospital, 598 patients with CRC were identified. The data of 448 consecutive patients who underwent surgery were analyzed. Tumors were resected by laparotomy in 366 patients (81.7 %), by laparoscopy in 76 patients (17.0 %) and by laparotomy after conversion in 6 patients (1.3 %). A clinical follow-up by the surgeon in 282 patients (62.9 %) with a mean duration of 33 months, yielded 49 patients with IH (17.4 %). The mean time of IH diagnosis (T1) was 19 months. Only 16 patients (33 %) underwent a hernia repair. For 363 patients (81.0 %), CT follow-up was available for a mean period of 30 months. In 84 patients (23.1 %), an IH was diagnosed with a mean T1 of 21 months. The review of all CTs by two independent radiologists yielded additional IH in 19 and 21 patients, respectively, increasing the IH rate to 29.1 and 29.7 %, respectively, and with a decrease in mean T1 to 14 months. The inter-observer agreement between the radiologists had a Kappa-statistic of 0.73 (95 % CI 0.65-0.81). For those patients with disagreement between the radiologists, a final agreement was made during an additional reviewing session of both radiologists, increasing the IH rate to 35.0 %. Comparing clinical follow-up, routine CT follow-up, and reassessed CT follow-up we found a statistically significant difference between the three methods of IH detection (p < 0.0001).
CT follow-up can identify significantly more IH than clinical examination alone, in particular if the radiologist focuses on IH development. Furthermore, we showed that focused CT evaluation diagnosed IH 7 months earlier than routine CT and 5 months earlier than clinical follow-up alone.
切口疝（IH）是结直肠癌（CRC）切除术后最常见的并发症。其发生率取决于随访方法，与单纯临床检查相比，超声可发现大量额外的疝。评估计算机断层扫描（CT）诊断IH价值的研究并不多。
CorreCT研究是一项对CRC手术后IH进行临床检查和CT检查的回顾性队列研究，数据来自医疗档案。两名放射科医生对所有CT进行了额外的独立复查。
从医院的肿瘤数据库（2004 - 2008年）中，确定了598例CRC患者。分析了448例连续接受手术患者的数据。366例患者（81.7%）通过开腹手术切除肿瘤，76例患者（17.0%）通过腹腔镜手术切除，6例患者（1.3%）通过中转开腹手术切除。282例患者（62.9%）由外科医生进行临床随访，平均随访时间为33个月，发现49例患者发生IH（17.4%）。IH诊断的平均时间（T1）为19个月。只有16例患者（33%）接受了疝修补术。363例患者（81.0%）有CT随访，平均随访时间为30个月。84例患者（23.1%）被诊断为IH，平均T1为21个月。两名独立放射科医生对所有CT的复查分别在19例和21例患者中发现了额外的IH，使IH发生率分别提高到29.1%和29.7%，且平均T1降至14个月。放射科医生之间的观察者间一致性Kappa统计值为0.73（95%CI 0.65 - 0.81）。对于放射科医生之间存在分歧的患者，在两位放射科医生的额外复查会议期间达成了最终一致，使IH发生率提高到35.0%。比较临床随访、常规CT随访和重新评估的CT随访，我们发现三种IH检测方法之间存在统计学显著差异（p < 0.0001）。
CT随访能比单纯临床检查发现更多的IH，特别是当放射科医生关注IH的发生时。此外，我们表明针对性的CT评估诊断IH比常规CT早7个月，比单纯临床随访早5个月。
