Virtual colonoscopy in stenosing colorectal cancer.
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%.


CONCLUSIONS
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.
Coccetta
Marco
M
Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
Migliaccio
Carla
C
Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
La Mura
Francesco
F
Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
Farinella
Eriberto
E
Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
Galanou
Ioanna
I
Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
Delmonaco
Pamela
P
Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
Spizzirri
Alessandro
A
Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
Napolitano
Vincenzo
V
Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
Cattorini
Lorenzo
L
Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
Milani
Diego
D
Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
Cirocchi
Roberto
R
Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
Sciannameo
Francesco
F
Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.