Bryce Adam S, Johnstone Mark S, Moug S J
School of Medicine, University of Glasgow, Glasgow, G12 8QQ, UK.
Int J Colorectal Dis. 2015 Jan;30(1):111-8. doi: 10.1007/s00384-014-2052-2. Epub 2014 Nov 7.
Colonoscopy detects colorectal cancer and determines lesion localisation that influences surgical planning. However, published work suggests that the accuracy of lesion localisation can be low as 60%, with implications for both the surgeon and the patient. This work aims to identify potential influencing factors at colonoscopy that could lead to improved lesion localisation accuracy.
A multi-centred, prospective, observational study was performed that identified patients who were undergoing planned curative resection for a colorectal lesion. Localisation of a lesion at colonoscopy was compared to the intra-operative lesion localisation to determine accuracy of colonoscopic localisation. Patient factors and colonoscopic factors were recorded to determine any influencing factors on lesion localisation at colonoscopy.
One hundred and eleven patients were analysed: mean age 67.4 years (range 27-89); male:female ratio 1.3:1; symptomatic referrals (n = 78, 70.3%); and previous abdominal surgery in 27 patients (24.3%). Complete colonoscopy was recorded in 78 patients (70.3%). In 88 patients (79.3%), colonoscopic lesion localisation matched the intra-operative location. Pre-operative CT imaging was unable to identify the tumour in 24 cases (21.8%). Potential influencing patient and colonoscopic factors on accurate lesion localisation at colonoscopy found complete colonoscopy to be the only significant factor (p = 0.008).
Colonoscopic lesion localisation was found to be inaccurate in 79.3% cases, and with pre-operative CT unable to detect all lesions, this study confirms that accurate lesion localisation in the modern era is increasingly reliant on colonoscopy. Incomplete colonoscopy was the only significant factor that influenced inaccurate lesion localisation at colonoscopy.
结肠镜检查可检测结直肠癌并确定病变位置，这会影响手术规划。然而，已发表的研究表明，病变定位的准确性可能低至60%，这对外科医生和患者都有影响。这项研究旨在确定结肠镜检查中可能导致病变定位准确性提高的潜在影响因素。
进行了一项多中心、前瞻性、观察性研究，确定了因结直肠病变计划进行根治性切除的患者。将结肠镜检查时病变的定位与术中病变定位进行比较，以确定结肠镜定位的准确性。记录患者因素和结肠镜因素，以确定结肠镜检查时病变定位的任何影响因素。
分析了111例患者：平均年龄67.4岁（范围27 - 89岁）；男女比例1.3:1；有症状转诊患者（n = 78，70.3%）；27例患者（24.3%）曾接受过腹部手术。78例患者（70.3%）完成了全结肠镜检查。88例患者（79.3%）结肠镜下病变定位与术中位置相符。术前CT成像在24例（21.8%）中未能识别出肿瘤。在结肠镜检查时，对准确病变定位有潜在影响的患者和结肠镜因素中，全结肠镜检查是唯一的显著因素（p = 0.008）。
发现79.3%的病例中结肠镜下病变定位不准确，且术前CT无法检测到所有病变，本研究证实现代精确的病变定位越来越依赖结肠镜检查。结肠镜检查不完整是影响结肠镜检查时病变定位不准确的唯一显著因素。
