title: Perioperative Colonic Evaluation in Patients with Rectal Cancer; MR Colonography Versus Standard Care.
abstract: OBJECTIVE
  Preoperative colonic evaluation is often inadequate because of cancer stenosis making a full conventional colonoscopy (CC) impossible. In several studies, cancer stenosis has been shown in up to 16%-34% of patients with colorectal cancer. The purpose of this study was to prospectively evaluate the completion rate of preoperative colonic evaluation and the quality of perioperative colonic evaluation using magnetic resonance colonography (MRC) in patients with rectal cancer.
  
  
  METHODS
  Patients diagnosed with rectal cancer were randomized to either group A: standard preoperative diagnostic work-up or group B: preoperative MR diagnostic work-up (standard preoperative diagnostic work-up + MRC). A complete and adequate perioperative clean-colon evaluation (PCE) was defined as either a complete preoperative colonic evaluation or a complete colonic evaluation within 3 months postoperatively.
  
  
  RESULTS
  Twenty-eight patients were randomized to group A and 28 to group B. Complete preoperative colonic evaluation with CC was achieved in 39% patients in group A and 93% for group B (Fisher's exact test, P < .001). PCE with CC was achieved in 64% and 93% in groups A and B, respectively (Fisher's exact test, P = .02). In group A, one synchronous cancer was found by CC. However, the location was misjudged as a sigmoid cancer. In group B, two synchronous cancers were found in the same patient who had an insufficient preoperative CC due to an obstructing rectal cancer.
  
  
  CONCLUSIONS
  MRC is a valuable tool and is recommended as part of the standard preoperative evaluation for patients with rectal cancer.
authors.affiliation: Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. Electronic address: michael.patrick.achiam.01@regionh.dk.
authors.forename: Michael Patrick
authors.initials: MP
authors.lastname: Achiam
authors.affiliation: Department of Diagnostic Radiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Løgager
authors.affiliation: Department of Diagnostic Radiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
authors.forename: Vera
authors.initials: V
authors.lastname: Lund Rasmussen
authors.affiliation: Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Cecilie
authors.initials: C
authors.lastname: Okholm
authors.affiliation: Department of Surgical Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
authors.forename: Talie
authors.initials: T
authors.lastname: Mollerup
authors.affiliation: Department of Diagnostic Radiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
authors.forename: Henrik S
authors.initials: HS
authors.lastname: Thomsen
authors.affiliation: Department of Surgical Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Rosenberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery
keywords: MR colonography; colonic evaluation; preoperative diagnostic work-up; rectal cancer; synchronous