Offermans T, Vogelaar F J, Aquarius M, Janssen-Heijnen M L G, Simons P C G
Department of Radiology, VieCuri Medical Centre, Venlo, The Netherlands.
Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands.
Eur J Surg Oncol. 2017 Nov;43(11):2105-2111. doi: 10.1016/j.ejso.2017.09.016. Epub 2017 Sep 20.
Adequate preoperative segmental localization of colorectal cancer is important to indicate the right surgical treatment. Preoperative localization has become more important in the era of minimally invasive surgery. The aim of this study was to compare optical colonoscopy (OC) and CT colonography (CTC) with respect to the error rates in the segmental localization of colorectal carcinoma.
A total of 420 patients with histopathologically proven colorectal carcinoma underwent CTC between December 2006 and February 2017. 284 Of these patients underwent surgical resection and had their carcinomas located on CTC report as well as OC report and surgical report. The segmental localization error rates of OC and CTC were compared using surgery as golden standard. McNemar's test was used to evaluate the differences in error rate.
284 Patients with a total of 296 colorectal carcinomas were evaluated. The segmental localization error rate of CTC (39/296, 13.2%) was found to be lower than the segmental localization error rate of OC (64/296, 21.6%) (p < 0.001). Per segment analysis showed that OC had a significantly higher error rate for carcinomas located in the descending colon (60.6% vs. 21.2% [p < 0.001] and cecum(60.0% vs. 23.3% [p = 0.001]). In 9.2% of the patients (26/284), localization based on CTC would lead to a change in surgical plan.
CTC has a lower localization error rate than OC, which is most relevant for tumors located in the descending colon. If there is a doubtful localization on OC, particularly in the left-sided colon, an additional CTC should be performed to choose the best surgical treatment.
结直肠癌术前准确的节段定位对于指导正确的手术治疗至关重要。在微创手术时代，术前定位变得更加重要。本研究的目的是比较光学结肠镜检查（OC）和CT结肠成像（CTC）在结直肠癌节段定位中的错误率。
2006年12月至2017年2月期间，共有420例经组织病理学证实的结直肠癌患者接受了CTC检查。其中284例患者接受了手术切除，其癌灶在CTC报告、OC报告及手术报告中均有定位。以手术作为金标准，比较OC和CTC的节段定位错误率。采用McNemar检验评估错误率的差异。
对284例共296个结直肠癌患者进行了评估。发现CTC的节段定位错误率（39/296，13.2%）低于OC的节段定位错误率（64/296，21.6%）（p<0.001）。按节段分析显示，OC对于降结肠癌（60.6%对21.2%[p<0.001]）和盲肠癌（60.0%对23.3%[p=0.001]）的错误率显著更高。在9.2%的患者（26/284）中，基于CTC的定位会导致手术方案的改变。
CTC的定位错误率低于OC，这对于降结肠肿瘤最为相关。如果OC上的定位存在疑问，特别是在左侧结肠，应额外进行CTC检查以选择最佳的手术治疗方案。
