title: Impact of contrast-enhanced computed tomography colonography on laparoscopic surgical planning of colorectal cancer.
abstract: OBJECTIVE
  To evaluate the impact of contrast-enhanced computed tomography colonography (CE-CTC) on laparoscopic surgery planning in patient with stenosing colorectal cancer.
  
  
  METHODS
  Sixty-nine patients with endoscopically proven colorectal cancer underwent CE-CTC, after incomplete conventional colonoscopy. Two experienced radiologists evaluated site, length, and TNM staging of colorectal cancers on three-dimensional double contrast enema-like views, 2D axial and multiplanar reconstructions. All the patients underwent colorectal resection and surgery bulletin, pathology of surgical specimens, and radiological follow-up at about 8 months were used as reference standard.
  
  
  RESULTS
  The detection rate of colorectal cancer was 100 % (75/75); CE-CTC allowed for a diagnosis of a synchronous colorectal cancer in five patients (7 %). CE-CTC correctly judged the site of the lesions in all the cases; clinically significant localization errors at conventional colonoscopy were noted in 3 out of 69 patients (4 %). Additional colonic polyps greater than 6 mm in diameter were found in 21 out of 69 patients (30 %); in two patients (3 %) the surgeon performed an enlarged colectomy to include synchronous polyps proximal to colorectal cancer. Sensitivity, specificity, PPV, NPV, and accuracy were for T1-T2 vs. T3-T4: 96 %, 71 %, 92 %, 87 %, and 91 %, respectively; for N: 94 %, 42 %, 64 %, 86 %, and 70 %; for M: 100 %, 100 %, 83 %, 100 %, and 97 %. There were no complications associated with CE-CTC.
  
  
  CONCLUSIONS
  Information given by CE-CTC concerning colorectal cancer location and synchronous colonic cancers and polyps changed the laparoscopic surgical strategy in almost 14 % of patients.
authors.affiliation: Unità Operativa di Radiologia Diagnostica e Interventistica, Azienda Ospedaliera San Paolo, Via A di Rudinì 8, 20142, Milan, Italy, nicola.flor@ao-sanpaolo.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Flor
authors.forename: Andrea Pisani
authors.initials: AP
authors.lastname: Ceretti
authors.forename: Miriam
authors.initials: M
authors.lastname: Mezzanzanica
authors.forename: Paolo
authors.initials: P
authors.lastname: Rigamonti
authors.forename: Mauro
authors.initials: M
authors.lastname: Peri
authors.forename: Silvia
authors.initials: S
authors.lastname: Tresoldi
authors.forename: Simone
authors.initials: S
authors.lastname: Soldi
authors.forename: Benedetto
authors.initials: B
authors.lastname: Mangiavillano
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Cornalba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023881:Colonography, Computed Tomographic / Q000379:methods*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D003287:Contrast Media; D003974:Diatrizoate Meglumine; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000601:surgery; D007479:Iopamidol / Q000031:analogs & derivatives; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; C057937:iomeprol; D003974:Diatrizoate Meglumine; D007479:Iopamidol