학술논문
CT prognostic signs of postoperative complications in emergency surgery for acute obstructive colonic cancer.
Document Type
Academic Journal
Author
Pezzullo F; Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy.; Comune R; Division of Radiology, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy.; D'Avino R; Department of Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy.; Mandato Y; Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy.; Liguori C; Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy.; Lassandro G; Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy.; Tamburro F; Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy.; Galluzzo M; Department of Emergency Radiology, San Camillo Forlanini Hospital, Rome, Italy.; Scaglione M; Department of Medicine, Surgery and Pharmacy, University of Sassari, Piazza Università, Sassari, Italy.; Department of Radiology, James Cook University Hospital, Middlesbrough, UK.; Tamburrini S; Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy. tamburrinistefania@gmail.com.
Source
Publisher: Springer Milan Country of Publication: Italy NLM ID: 0177625 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1826-6983 (Electronic) Linking ISSN: 00338362 NLM ISO Abbreviation: Radiol Med Subsets: MEDLINE
Subject
Language
English
Abstract
Purpose: To identify CT prognostic signs of poor outcomes in acute obstructive colonic cancer (AOCC).
Methods: Demographic, clinical, laboratory, radiological and surgical data of 65 consecutive patients with AOCC who underwent emergency surgery were analyzed. CT exams were reviewed to assess diameters of cecum, ascending, transverse, descending, and sigmoid proximal to the tumor; colon segments' CD/L1-VD ratios, continence of the ileocecal valve, small bowel overdistension, presence of small bowel feces sign and cecal pneumatosis. Post Operative complications (PO), according to the Clavien-Dindo classification, were analyzed.
Results: Gender, age and location of the tumor were not predictive factors of complications. Among laboratory exams, CRP was the most important predictive value of PO (OR 8.23). A cecum distension ≥ 9 cm represented the critical diameter beyond which perforation and cecal necrosis were found at surgery. Cecal pneumatosis at CT was correlated with cecal necrosis at surgery in < 50% of patients. Pre-operative transverse colon CD/L1-VD ratio ≥ 1.43 and descending colon CD/L1-VD ratio ≥ 1.31 were associated with the development of PO (grade ≥ III-V). PO (grade ≥ III-V) occurred in 18/65 patients.
Conclusion: Postoperative complications in emergency surgery of AOCC were not related to the age, sex and tumor's location. Preoperative PCR values (≥ 2.17) predict the development of postoperative complications. CT resulted a valid diagnostic tool to identify patients at higher risk of complications: a CD/L1-VD ratios with cut-off values of 1.43 (transverse) and 1.31 (descending) predicted major complications (grade ≥ III-V) and a cecum distension ≥ 9 cm represented the critical diameter beyond which perforation occurred in > 84% of patients.
(© 2024. Italian Society of Medical Radiology.)
Methods: Demographic, clinical, laboratory, radiological and surgical data of 65 consecutive patients with AOCC who underwent emergency surgery were analyzed. CT exams were reviewed to assess diameters of cecum, ascending, transverse, descending, and sigmoid proximal to the tumor; colon segments' CD/L1-VD ratios, continence of the ileocecal valve, small bowel overdistension, presence of small bowel feces sign and cecal pneumatosis. Post Operative complications (PO), according to the Clavien-Dindo classification, were analyzed.
Results: Gender, age and location of the tumor were not predictive factors of complications. Among laboratory exams, CRP was the most important predictive value of PO (OR 8.23). A cecum distension ≥ 9 cm represented the critical diameter beyond which perforation and cecal necrosis were found at surgery. Cecal pneumatosis at CT was correlated with cecal necrosis at surgery in < 50% of patients. Pre-operative transverse colon CD/L1-VD ratio ≥ 1.43 and descending colon CD/L1-VD ratio ≥ 1.31 were associated with the development of PO (grade ≥ III-V). PO (grade ≥ III-V) occurred in 18/65 patients.
Conclusion: Postoperative complications in emergency surgery of AOCC were not related to the age, sex and tumor's location. Preoperative PCR values (≥ 2.17) predict the development of postoperative complications. CT resulted a valid diagnostic tool to identify patients at higher risk of complications: a CD/L1-VD ratios with cut-off values of 1.43 (transverse) and 1.31 (descending) predicted major complications (grade ≥ III-V) and a cecum distension ≥ 9 cm represented the critical diameter beyond which perforation occurred in > 84% of patients.
(© 2024. Italian Society of Medical Radiology.)