Department of General Surgery, University of Health Sciences İzmir Tepecik Training and Research Hospital, İzmir-Türkiye.
Department of Radiology, University of Health Sciences İzmir Tepecik Training and Research Hospital, İzmir-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2022 Sep;28(9):1248-1257. doi: 10.14744/tjtes.2021.67792.
In acute obstructive left-sided colorectal cancers (AOLCRC), damage to the colon wall may occur as a result of distension of the colon segments proximal to the tumor. In this study, we aimed to evaluate the relationship between the ratio of dilated colon diameter (CD) to lumbar vertebral corpus diameter on preoperative abdominal computed tomography (CT) scan in patients undergoing Hartmann's Procedure (HP) and post-operative complications.
The tumor group consisted of 49 patients who underwent HP for AOLCRC under emergency conditions. The control group consisted of 49 age-and gender-matched individuals (compatible with tumor group) that had an abdominal CT due to pathologies outside the gastrointestinal tract and without a history of abdominal surgery. In both group, the ratios of the CD to the diameter of the first lumbar vertebra corpus (L1-VD) measured on axial CT images of each patient. These ratios were compared between groups. In the tumor group, the relationship between post-operative complications (Clavien-Dindo classification-major (grade ≥III), minor (grade <III)) and demographic characteristics, pre-operative biochemical values, comorbid diseases, tumor pathological stage, operation time, and colon segments' CD/L1-VD ratios was evaluated.
The CD/L1-VD ratio in the tumor group was significantly higher than that of the control group (p<0.001). An increase in the pre-operative transverse and descending colon CD/L1-VD ratios in the tumor group were found to be a prognostic parameter for the development of major post-operative complications (p<0.001 and p=0.015, respectively), with the cut-off values as 1.52 and 1.21 (p=0.013 and p=0.042), respectively. The increase in the pre-operative transverse colon CD/L1-VD ratio was also associated with the increase in the blood urea level (p=0.044). A positive correlation was observed between the pre-operative blood urea levels and post-operative complications (p=0.015).
Pre-operative transverse and descending colon CD/L1-VD ratios in AOLCRC are promising prognostic parameters for major postoperative complications.
在急性梗阻性左侧结直肠癌（AOLCRC）中，由于肿瘤近端结肠节段的扩张，可能会导致结肠壁受损。在这项研究中，我们旨在评估接受Hartmann 手术（HP）的患者术前腹部 CT（CT）扫描中扩张结肠直径（CD）与腰椎体直径的比值与术后并发症之间的关系。
肿瘤组由 49 例因 AOLCRC 而行 HP 的患者组成，这些患者均为紧急情况。对照组由 49 名年龄和性别与肿瘤组相匹配的个体组成（与肿瘤组相匹配），这些患者因胃肠道以外的疾病而行腹部 CT 检查，且无腹部手术史。在两组患者中，均测量每位患者轴向 CT 图像上 CD 与第一腰椎体直径（L1-VD）的比值。比较两组之间的比值。在肿瘤组中，评估了术后并发症（Clavien-Dindo 分级主要（等级≥III）、次要（等级<III））与人口统计学特征、术前生化值、合并症、肿瘤病理分期、手术时间和结肠节段 CD/L1-VD 比值之间的关系。
肿瘤组的 CD/L1-VD 比值明显高于对照组（p<0.001）。肿瘤组术前横结肠和降结肠 CD/L1-VD 比值的增加被发现是发生主要术后并发症的预后参数（p<0.001 和 p=0.015），截断值分别为 1.52 和 1.21（p=0.013 和 p=0.042）。术前横结肠 CD/L1-VD 比值的增加也与血尿素水平的升高相关（p=0.044）。术前血尿素水平与术后并发症之间存在正相关（p=0.015）。
AOLCRC 中术前横结肠和降结肠 CD/L1-VD 比值是预测主要术后并发症的有前途的预后参数。
