Colorectal Surgery Unit, Department of Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
Department of Gastroenterology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
ANZ J Surg. 2021 Oct;91(10):2121-2125. doi: 10.1111/ans.17038. Epub 2021 Jun 28.
Colorectal cancer is a major cause of morbidity and mortality worldwide. Optimal management of this disease relies upon accurate pre-operative localisation to allow multidisciplinary discussion and treatment planning. Current pre-operative localisation methods consist of colonoscopy and computed tomography (CT), which are only 79%-85% accurate. To minimise this error, colonoscopy tattooing is a routine practice to facilitate operative localisation. The aim of this study is to investigate if endoscopic radiopaque clips can more accurately localise the lesions pre-operatively.
A retrospective case-control study was conducted of patients diagnosed with colorectal cancer at a tertiary hospital between 2017 and 2019. Visualisation rates and accurate localisation rates were compared between patients receiving radiopaque clips and those who had colonoscopy alone. All patients received a tattoo distal to the tumour and a staging CT. Data on patient demographics, tumour demographics, post-procedure complications and changes to surgical management were collected.
Of 285 patients, 245 had tumour localisation with colonoscopy alone and 40 had additional clip localisation. Groups had comparable patient demographics. For patients receiving clips and follow-up CTs within 14 days, 92% of lesions were visualised and 100% of these lesions were accurately localised. In contrast, colonoscopy only accurately localised 77% of lesions (p < 0.01). This resulted in 1.2% of patients requiring an altered operation due to incorrect localisation. No clip-related complications were reported.
Radiopaque clips are a highly accurate and cost-effective method for localising colorectal cancer with a pre-operative accuracy rate over 92%.
结直肠癌是全球发病率和死亡率的主要原因。这种疾病的最佳治疗方案取决于术前的精确定位，以实现多学科讨论和治疗计划。目前的术前定位方法包括结肠镜检查和计算机断层扫描（CT），其准确率仅为 79%-85%。为了减少这种误差，结肠镜下纹身是一种常规做法，以方便手术定位。本研究旨在探讨内镜不透射线夹是否可以更准确地术前定位病变。
对 2017 年至 2019 年在一家三级医院诊断为结直肠癌的患者进行了回顾性病例对照研究。比较了接受不透射线夹和单独接受结肠镜检查的患者的可视化率和准确定位率。所有患者均接受了肿瘤远端的纹身和分期 CT。收集了患者人口统计学、肿瘤人口统计学、术后并发症和手术管理改变的数据。
在 285 名患者中，245 名患者单独接受结肠镜检查进行肿瘤定位，40 名患者接受额外的夹定位。两组患者的人口统计学特征相似。对于接受夹和 14 天内的后续 CT 的患者，92%的病变可见，100%的病变可准确定位。相比之下，结肠镜检查仅能准确定位 77%的病变（p<0.01）。这导致 1.2%的患者因定位错误需要改变手术。未报告与夹子相关的并发症。
不透射线夹是一种高度准确且具有成本效益的方法，可用于定位结直肠癌，术前准确率超过 92%。
