Farouk R, Nelson H, Radice E, Mercill S, Gunderson L
Division of Colon and Rectal Surgery, Mayo Foundation, Rochester, Minnesota, USA.
Am J Surg. 1998 Apr;175(4):283-7. doi: 10.1016/s0002-9610(98)00017-8.
To determine the accuracy of computed axial tomography (CT) in determining tumor resectability in patients with locally advanced primary (T4) or locally recurrent colorectal cancer.
Computed tomography scans of 84 patients with "resectable" locally advanced primary rectal cancer (n = 12) or recurrent colorectal cancer (n = 72) were compared with the operative findings to assess the accuracy of abdominal and pelvic CT in determining extent of disease and resectability.
At surgery, disease was confined to the pelvis in 63 patients, the abdomen in 7, and involved both the pelvis and abdomen in 14. Computed tomography correctly identified these anatomic sites of tumor in 87% of patients, with 89% and 80% accuracies for pelvic and abdominal disease, respectively. Tumor resection was performed in 71 patients (85%), but was not in 13 patients because of locally unresectable disease in 8 and metastatic disease in 5. The accuracy of predicting tumor-related operability was 85%. With regard to adjacent organ resection, CT was accurate in determining the need for sacrectomy or hysterectomy, but overestimated the need for urinary organ resection. Based on histological examination of resection margins, CT correctly staged (n = 45) or overstaged (n = 9) 54 patients (64%) and understaged the remaining 30. The ability of CT to preoperatively predict a locally advanced tumor after preoperative radiation therapy as not being fixed was 30%, fixed but resectable 75%, and fixed but not resectable 25%.
Computed tomography is generally reliable at identifying disease as being confined to one region, and for predicting the need for adjacent organ resection. It is less discriminating for predicting local tumor resectability.
确定计算机断层扫描（CT）在判断局部晚期原发性（T4）或局部复发性结直肠癌患者肿瘤可切除性方面的准确性。
对84例“可切除”的局部晚期原发性直肠癌（n = 12）或复发性结直肠癌（n = 72）患者的CT扫描结果与手术所见进行比较，以评估腹部和盆腔CT在确定疾病范围和可切除性方面的准确性。
手术时，63例患者的疾病局限于盆腔，7例局限于腹部，14例同时累及盆腔和腹部。CT在87%的患者中正确识别了肿瘤的这些解剖部位，对盆腔和腹部疾病的准确率分别为89%和80%。71例患者（85%）进行了肿瘤切除，但13例患者未进行切除，原因是8例患者存在局部不可切除的疾病，5例患者存在转移性疾病。预测肿瘤相关可操作性的准确率为85%。关于相邻器官切除，CT在确定是否需要骶骨切除术或子宫切除术方面准确，但高估了泌尿器官切除的必要性。根据切除边缘的组织学检查，CT对54例患者（64%）进行了正确分期（n = 45）或过度分期（n = 9），其余30例患者分期过低。CT术前预测术前放疗后局部晚期肿瘤未固定的能力为30%，固定但可切除的能力为75%，固定但不可切除的能力为25%。
CT在识别疾病局限于一个区域以及预测相邻器官切除的必要性方面通常是可靠的。在预测局部肿瘤可切除性方面，其鉴别能力较差。
