From the Department of Radiology and Research Institute of Radiology (B.K., S.H.P., S.S.L., A.Y.K., H.K.H.), Department of Pathology (J.K.), Department of Colorectal Surgery (J.C.K., C.S.Y.), and Department of Gastroenterology (S.K.Y.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, University of Wisconsin Medical School, Madison, Wis (P.J.P.); and Medical Research Collaborating Center, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (S.A.).
Radiology. 2014 Oct;273(1):99-107. doi: 10.1148/radiol.14132844. Epub 2014 Jun 11.
To determine the postoperative incidence of adenomatous neoplasia in the colon proximal to an occlusive colorectal cancer where preoperative computed tomographic (CT) colonography findings were normal.
Institutional review board approval, with a waiver of informed consent, was obtained. This observational study included patients with occlusive colorectal cancer who underwent preoperative CT colonography between April 2007 and March 2010 that revealed normal findings (ie, no lesions ≥ 6 mm) in the proximal colon and who underwent postoperative colonoscopy. The primary outcome was postoperative colonoscopic discovery of clinically relevant lesions (ie, nondiminutive [≥ 6 mm] adenomas, advanced adenomas, or cancers) in the proximal colon. The cumulative incidence of clinically relevant lesions in preoperatively normal proximal colon over the postsurgical follow-up time was analyzed by using the Kaplan-Meier method.
The final cohort included 204 patients (102 men and 102 women; mean age, 57.3 years ± 11.3 [standard deviation]). At a total of 435 postoperative colonoscopies performed over a median follow-up of 29 months (range, 1-74 months), clinically relevant lesions were detected in the proximal colon in 30 patients: Nonadvanced adenomas were detected in 23 patients, and advanced adenomas were detected in seven patients. The cumulative incidence of clinically relevant adenomatous lesions in the preoperatively normal proximal colon 12 and 18 months after preoperative CT colonography was 8.1% (95% confidence interval [CI]: 3.9%, 12.2%) and 9.6% (95% CI: 5%, 14%), respectively. Clinically relevant adenomatous lesions found in the proximal colon within 18 months of preoperative CT colonography were nonadvanced adenomas in 10 of 15 patients.
When the portion of the colon proximal to an occlusive cancer is devoid of nondiminutive lesions at preoperative CT colonography, colonoscopy of the proximal colon following cancer resection rarely finds clinically relevant lesions and is unlikely to reveal any lesions requiring immediate removal until routine 1-year postsurgical follow-up. Online supplemental material is available for this article .
确定术前计算机断层（CT）结肠成像检查结果正常的阻塞性结直肠癌近端结肠的腺瘤性肿瘤的术后发生率。
本研究获得机构审查委员会批准（豁免知情同意）。这项观察性研究纳入了 2007 年 4 月至 2010 年 3 月期间因阻塞性结直肠癌接受术前 CT 结肠成像检查且近端结肠未见异常（即，无 ≥ 6mm 的病变）并随后接受术后结肠镜检查的患者。主要结局是术后结肠镜检查发现近端结肠存在临床相关病变（即非小（≥ 6mm）腺瘤、高级别腺瘤或癌症）。采用 Kaplan-Meier 方法分析术前正常近端结肠在术后随访时间内出现临床相关病变的累积发生率。
最终纳入 204 例患者（男 102 例，女 102 例；平均年龄 57.3 岁±11.3[标准差]）。中位随访 29 个月（范围，1-74 个月）时共进行了 435 次术后结肠镜检查，在 30 例患者的近端结肠中发现了临床相关病变：23 例患者发现非高级别腺瘤，7 例患者发现高级别腺瘤。术前 CT 结肠成像后 12 个月和 18 个月时，术前正常近端结肠发生临床相关腺瘤性病变的累积发生率分别为 8.1%（95%置信区间：3.9%，12.2%）和 9.6%（95%置信区间：5%，14%）。术前 CT 结肠成像后 18 个月内发现的近端结肠临床相关腺瘤性病变中，15 例患者中有 10 例为非高级别腺瘤。
当阻塞性癌症近端结肠无小病变时，在癌症切除术后进行近端结肠结肠镜检查很少发现临床相关病变，并且不太可能在常规术后 1 年随访前发现任何需要立即切除的病变。本文提供了在线补充材料。
