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Hao Q, Qin D, Li Z, Dong N, Zhang S. Detection methods of synchronous colorectal lesions in proximal colon for patients with obstructive colorectal cancer: a literature review. Expert Rev Gastroenterol Hepatol 2022; 16:511-519. [PMID: 35673978 DOI: 10.1080/17474124.2022.2085555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Colorectal cancer holds a high morbidity and mortality rate. As a common method for colorectal cancer detection, colonoscopy has difficulty in passing through the malignant stenosis in patients with obstructive colorectal cancer, which results in incomplete detection and missed diagnosis. The missed synchronous lesions increase the risk of metachronous cancer. Therefore, detecting proximal synchronous lesions in patients with obstructive colorectal cancer should be appreciated before operation. AREA COVERED This review evaluates related literature, aiming at providing clinicians with more ideas and attention for detecting proximal synchronous lesions in patients with obstructive colorectal cancer. EXPERT OPINION In patients with obstructive colorectal cancer, missed diagnosis of lesions proximal to the obstruction may lead to metachronous colorectal cancer. Except for preoperative colonoscopy which is difficult to pass through malignant stenosis, other methods that can evaluate proximal colon segment are critical. This article introduced several preoperative, intraoperative and postoperative measures for synchronous lesions detection. The choice of methods should base on patients' conditions, aiming at a high diagnostic yield and low risk. Early detection and resection of synchronous lesions in the proximal section of malignant obstruction are expected to minimize the risk of metachronous colorectal cancer and even effect follow-up treatment strategy, which deserves the attention of clinicians.
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Affiliation(s)
- Qiyuan Hao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, Peking, China.,National Clinical Research Center for Digestive Diseases, Beijing, Peking, China.,Beijing Digestive Disease Center, Beijing, Peking, China
| | - Da Qin
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, Peking, China.,National Clinical Research Center for Digestive Diseases, Beijing, Peking, China.,Beijing Digestive Disease Center, Beijing, Peking, China
| | - Zhiyu Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, Peking, China.,National Clinical Research Center for Digestive Diseases, Beijing, Peking, China.,Beijing Digestive Disease Center, Beijing, Peking, China
| | - Ningning Dong
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, Peking, China.,National Clinical Research Center for Digestive Diseases, Beijing, Peking, China.,Beijing Digestive Disease Center, Beijing, Peking, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, Peking, China.,National Clinical Research Center for Digestive Diseases, Beijing, Peking, China.,Beijing Digestive Disease Center, Beijing, Peking, China
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Yang B, Gan Z, Liu S, Li M, Si G, He Q. Value of multi-slice spiral computerized tomography for diagnosis of synchronous colorectal carcinoma: a retrospective study. J Int Med Res 2022; 50:3000605221076060. [PMID: 35135382 PMCID: PMC8832595 DOI: 10.1177/03000605221076060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the accuracy of multi-slice spiral computerized tomography (MSCT) with colonoscopy for diagnosing synchronous colorectal carcinoma (SCC). Methods We retrospectively analyzed all consecutive patients admitted to our institution with colorectal carcinoma between 19 September 2014 and 31 January 2020. Data on SCC patients who had undergone MSCT and colonoscopy were analyzed. Information on tumor location, tumor size, missed diagnosis by MSCT or colonoscopy, T stage, pathological type, and reasons for missed diagnosis was recorded and used to assess the diagnostic accuracies of MSCT and colonoscopy. Results Twenty-three cases met the inclusion criteria. MSCT plus colonoscopy had a significantly higher diagnostic accuracy (93.5%) than colonoscopy alone. There were significant differences in missed diagnosis rates of proximal cancer (34.8%) and distal cancer (4.3%) by colonoscopy. For MSCT, the missed diagnosis rate for tumors with a median long diameter of 1.25 cm (interquartile range 0.80, 1.50) was significantly lower than that for larger tumors (long diameter 4.00 cm; 3.00, 6.00). Conclusions MSCT is a valuable diagnostic tool for SCC that can effectively minimize the missed diagnosis rate of primary tumors when combined with colonoscopy.
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Affiliation(s)
- Bin Yang
- Department of Radiology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, Sichuan, People's Republic of China
| | - Zhonghua Gan
- Department of Radiology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, Sichuan, People's Republic of China
| | - Shulan Liu
- Department of Radiology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, Sichuan, People's Republic of China
| | - Mingxia Li
- Department of Radiology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, Sichuan, People's Republic of China
| | - Guangyan Si
- Department of Radiology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, Sichuan, People's Republic of China
| | - Qizhou He
- Department of Radiology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, Sichuan, People's Republic of China
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Flor N, Zanchetta E, Di Leo G, Mezzanzanica M, Greco M, Carrafiello G, Sardanelli F. Synchronous colorectal cancer using CT colonography vs. other means: a systematic review and meta-analysis. Abdom Radiol (NY) 2018; 43:3241-3249. [PMID: 29948053 DOI: 10.1007/s00261-018-1658-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The objective of our study was to systematically review the evidence about synchronous colorectal cancer diagnosed with or without computed tomography colonography (CTC). MATERIALS AND METHODS Two systematic searches were performed (PubMed and EMBASE) for studies reporting the prevalence of synchronous colorectal cancer (CRC): one considering patients who underwent CTC and the another one considering patients who did not undergo CTC. A three-level analysis was performed to determine the prevalence of patients with synchronous CRC in both groups of studies. Heterogeneity was explored for multiple variables. Pooled prevalence and 95% confidence interval (CI) were calculated. A quality assessment (STROBE) was done for the studies. RESULTS For CTC studies, among 2645 articles initially found, 21 including 1673 patients, published from 1997 to 2018, met the inclusion criteria. For non-CTC studies, among 6192 articles initially found, 27 including 111,873 patients published from 1974 to 2015 met the inclusion criteria. The pooled synchronous CRC prevalence was 5.7% (95% CI 4.7%-7.1%) for CTC studies, and 3.9% (95% CI 3.3%-4.4%) for non-CTC studies, with a significant difference (p = 0.004). A low heterogeneity was found for the CTC group (I2 = 10.3%), whereas a high heterogeneity was found in the non-CTC group of studies (I2 = 93.5%), and no significant explanatory variables were found. Of the 22 STROBE items, a mean of 18 (82%) was fulfilled by CTC studies, and a mean of 16 (73%) by non-CTC studies. CONCLUSIONS The prevalence of synchronous CRC was about 4-6%. The introduction of CTC is associated with a significant increase of the prevalence of synchronous CRCs.
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Affiliation(s)
- Nicola Flor
- Unità Operativa di Radiologia Diagnostica e Interventistica, Azienda Servizi Socio Territoriali Santi Paolo e Carlo, Presidio San Paolo, Via di Rudinì 8, 20142, Milan, Italy.
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via di Rudinì 8, 20142, Milan, Italy.
| | - Edoardo Zanchetta
- Postgraduation School in Radiodiagnostics, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Giovanni Di Leo
- Unità di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Dipartimento di Scienze Biomediche della Salute, Università degli Studi di Milano, Piazza E. Malan, 20097, San Donato Milanese, Italy
| | - Miriam Mezzanzanica
- Postgraduation School in Radiodiagnostics, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Massimiliano Greco
- Postgraduation School in Radiodiagnostics, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Gianpaolo Carrafiello
- Unità Operativa di Radiologia Diagnostica e Interventistica, Azienda Servizi Socio Territoriali Santi Paolo e Carlo, Presidio San Paolo, Via di Rudinì 8, 20142, Milan, Italy
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via di Rudinì 8, 20142, Milan, Italy
| | - Francesco Sardanelli
- Unità di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Dipartimento di Scienze Biomediche della Salute, Università degli Studi di Milano, Piazza E. Malan, 20097, San Donato Milanese, Italy
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Offermans T, Vogelaar FJ, Aquarius M, Janssen-Heijnen MLG, Simons PCG. The added clinical value of performing CT colonography in patients with obstructing colorectal carcinoma. Gastroenterol Rep (Oxf) 2018; 6:210-214. [PMID: 32537167 PMCID: PMC7282274 DOI: 10.1093/gastro/goy003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 12/20/2017] [Accepted: 12/26/2017] [Indexed: 11/30/2022] Open
Abstract
Background A small percentage of incomplete optical colonoscopies (OCs) are the result of an obstructing tumor. According to current guidelines, CT colonography (CTC) is performed to prevent missing a synchronous tumor. The aim of this study was to evaluate how frequently a synchronous tumor was found on CTC and how often this led to a change in the surgical plan. Methods In this retrospective study, a total of 267 patients underwent CTC after an incomplete OC as a result of an obstructing colorectal carcinoma (CRC). Among them, 210 patients undergoing surgery met the inclusion criteria and were included in the analysis. The OC report, CTC report and surgical report of these patients were retrospectively evaluated for the presence of synchronous tumors using surgery and post-operative colonoscopy as the gold standard. Results Six of the 210 patients (2.9%) showed signs of a synchronous CRC proximal to the obstructing tumor on CTC. In three of these patients, a synchronous CRC was confirmed during surgery. All these tumors caused a change in the surgical plan. Three out of the six tumors found on CTC were found to be large, non-malignant polyps. All these polyps were located in the same segment as the obstructing tumor and therefore did not alter the surgical plan. Conclusion In patients with obstructing CRC, the frequency of synchronous CRCs proximal to this lesion is low. Performing a CTC leads to a change in surgical plan based on the presence of these synchronous tumors in 1.4% of the cases. CTC should be employed as a one-stop shop in patients with an obstructing CRC.
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Affiliation(s)
- Tom Offermans
- Department of Radiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - F Jeroen Vogelaar
- Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - Michel Aquarius
- Department of Gastroenterology, VieCuri Medical Centre, Venlo, The Netherlands
| | - Maryska L G Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands.,Department of Epidemiology, Maastricht University Medical Centre, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Petra C G Simons
- Department of Radiology, VieCuri Medical Centre, Venlo, The Netherlands
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De Rosa M, Rondelli F, Stella P, Boni M, Ermili F, Ceccarelli G. Triple synchronous colorectal carcinoma. ANZ J Surg 2018; 89:E329-E330. [PMID: 29510452 DOI: 10.1111/ans.14452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 01/29/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Michele De Rosa
- Department of General Surgery, 'San Giovanni Battista' Hospital, Perugia, Italy
| | - Fabio Rondelli
- Department of General Surgery, 'San Giovanni Battista' Hospital, Perugia, Italy.,Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Paolo Stella
- Department of General Surgery, 'San Giovanni Battista' Hospital, Perugia, Italy
| | - Marcello Boni
- Department of General Surgery, 'San Giovanni Battista' Hospital, Perugia, Italy
| | - Fabio Ermili
- Department of General Surgery, 'San Giovanni Battista' Hospital, Perugia, Italy
| | - Graziano Ceccarelli
- Department of General Surgery, 'San Giovanni Battista' Hospital, Perugia, Italy
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Jiang X, Xu C, Tang D, Wang D. Laparoscopic subtotal colectomy for synchronous triple colorectal cancer: A case report. Oncol Lett 2016; 12:1525-1528. [PMID: 27446464 PMCID: PMC4950764 DOI: 10.3892/ol.2016.4803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 05/23/2016] [Indexed: 02/07/2023] Open
Abstract
Synchronous colorectal cancers refer to the simultaneous occurrence of multiple colorectal tumors in a single patient, excluding any metastases from other organs. At present, radical surgery is considered the standard curative treatment; however, individualized surgical strategies depend on tumor location, the depth of invasion and the general health of the patient. In the present study, the case of a 52-year-old man who presented with a 2-month history of abdominal pain that was accompanied by intermittent hematochezia and weight loss is reported. The patient had no family history of cancer. Computed tomography (CT) of the abdomen revealed intestinal wall thickness in the transverse colon and volvulus in the hepatic flexure of colon. Colonoscopy identified 3 tumors: The first tumor was located in the descending colon with lumen stenosis ~60 cm from the anal verge, the second tumor was located in the hepatic flexure of the colon, and the third tumor was located in the sigmoid colon, 23 cm from the anal verge. Subsequently, laparoscopic subtotal colectomy was performed and all three tumors were removed, and the diagnosis was confirmed by histopathological examination. The patient did not undergo chemotherapy following surgery, due to personal reasons. Subsequent to 19 months of follow-up examinations using CT and colonoscopy every 6 months, the patient exhibited no signs of recurrence. Thus, laparoscopic subtotal colectomy represents an effective surgical approach for the treatment of synchronous colorectal cancer following imaging and endoscopic diagnosis.
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Affiliation(s)
- Xuetong Jiang
- Department of Gastrointestinal Surgery, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu, Yangzhou, Jiangsu 225001, P.R. China
| | - Chuanqi Xu
- Department of Gastrointestinal Surgery, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu, Yangzhou, Jiangsu 225001, P.R. China
| | - Dong Tang
- Department of Gastrointestinal Surgery, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu, Yangzhou, Jiangsu 225001, P.R. China
| | - Daorong Wang
- Department of Gastrointestinal Surgery, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu, Yangzhou, Jiangsu 225001, P.R. China
- Correspondence to: Professor Daorong Wang, Department of Gastrointestinal Surgery, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu, 98 Nantong West Road, Yangzhou, Jiangsu 225001, P.R. China, E-mail:
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