Case study

Virtual colonoscopy in stenosing colorectal cancer

Marco Coccetta^* , Carla Migliaccio^* , Francesco La Mura^* , Eriberto Farinella^* , Ioanna Galanou^* , Pamela Delmonaco^* , Alessandro Spizzirri^* , Vincenzo Napolitano^* , Lorenzo Cattorini^* , Diego Milani^* , Roberto Cirocchi^* and Francesco Sciannameo^*

Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy

author email corresponding author email* Contributed equally

Annals of Surgical Innovation and Research 2009, 3:11doi:10.1186/1750-1164-3-11

Published:	9 November 2009

Abstract

Background

Between 5 and 10% of the patients undergoing a colonoscopy cannot have a complete procedure mainly due to stenosing neoplastic lesion of rectum or distal colon. Nevertheless the elective surgical treatment concerning the stenosis is to be performed after the pre-operative assessment of the colonic segments upstream the cancer.

The aim of this study is to illustrate our experience with the Computed Tomographic Colonography (CTC) for the pre-operative assessment of the entire colon in the patients with stenosing colorectal cancers.

Methods

From January 2005 till March 2009, we observed and treated surgically 43 patients with stenosing colorectal neoplastic lesions. All patients did not tolerate the pre-operative colonoscopy. For this reason they underwent a pre-operative CTC in order to have a complete assessment of the entire colon. All patients underwent a follow-up colonoscopy 3 months after the surgical treatment. The CTC results were compared with both macroscopic examination of the specimen and the follow-up coloscopy.

Results

The pre-operative CTC showed four synchronous lesions in four patients (9.3% of the cases). The macroscopic examination of the specimen revealed three small sessile polyps (3 - 4 mm in diameter) missed in the pre-operative assessment near the stenosing colorectal cancer. The follow-up colonoscopy showed four additional sessile polyps with a diameter between 3 - 11 mm in three patients.

Our experience shows that CTC has a sensitivity of 83,7%.

Conclusion

In patients with stenosing colonic lesions, CTC allows to assess the entire colon pre-operatively avoiding the need of an intraoperative colonoscopy. More synchronous lesions are detected and treated at the time of the elective surgery for the stenosing cancer avoiding further surgery later on.