title: The strengths and limitations of routine staging before treatment with abdominal CT in colorectal cancer.
abstract: BACKGROUND
  Advanced colorectal cancer (CRC), either locally advanced, metastasized (mCRC) or both, is present in a relevant proportion of patients. The chances on curation of advanced CRC are continuously improving with modern multi-modality treatment options. For incurable CRC the focus lies on palliation of symptoms, which is not necessarily a resection of the primary tumor. Both situations motivate adequate staging before treatment in CRC. This prospective observational study evaluates the outcomes after the introduction of routine staging with abdominal CT before treatment.
  
  
  METHODS
  In a prospective observational study of 612 consecutive patients (2007-2009), the ability of abdominal CT to find liver metastases (LM), peritoneal carcinomatosis (PC) and T4 stage in colon cancer (CC) was analysed.
  
  
  RESULTS
  Advanced CRC was present in 58% of patients, mCRC in 31%. The ability to find LM was excellent (99%), cT4 stage CC good (86%) and PC poor (33%). In the group of surgical patients with emergency presentations, the incidences of both mCRC (51%) and locally advanced colon cancer (LACC) (69%) were higher than in the elective group (20% and 26% respectively). Staging tended to be omitted more often in the emergency group (35% versus 12% in elective surgery).
  
  
  CONCLUSIONS
  The strengths of staging with abdominal CT are to find LM and LACC, however it fails in diagnosing PC. On grounds of the incidence of advanced CRC, staging is warranted in patients with emergency presentations as well.
authors: Department of Surgery, University Medical Center Groningen, Hanzeplein 1, Groningen 9713 GZ, the Netherlands. irenegrossmann@me.com
authors: Irene
authors: I
authors: Grossmann
authors: Joost M
authors: JM
authors: Klaase
authors: Johannes Ka
authors: JK
authors: Avenarius
authors: Ignace Hjt
authors: IH
authors: de Hingh
authors: Walter Jb
authors: WJ
authors: Mastboom
authors: Theo
authors: T
authors: Wiggers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods / Q000592:standards*; D009426:Netherlands / Q000453:epidemiology; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed