Rationale and Objectives
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.
Materials and 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.
Introduction
Colorectal cancer is the third most common cancer in men and the second in women worldwide. At this time, it is estimated that 1.361 million new cases and 694 million deaths are caused every year by colorectal cancer, and most patients die from synchronous and metachronous lesions . Thus, a thorough preoperative (PREOP) diagnostic work-up is necessary. It is often comprised of a computed tomography (CT) of the thorax and abdomen along with colonic evaluation. In case of rectum cancer, an evaluation of the tumor by transrectal ultrasound or magnetic resonance (MR) is also performed. The PREOP diagnostic work-up is performed to find synchronous lesions; liver metastases are found in up to 19% of patients , colon cancer in 2%–11% and up to 61% of patients with polyps . The diagnosis of synchronous liver metastases is primarily used for determination of resectability, whereas the diagnosis of synchronous colonic lesions is for planning of surgical strategy. The presence of synchronous colonic lesions in patients with colon cancer was described already in 1922 ; more than 30 years ago, it was recommended to do PREOP colonic evaluation . For the time being, it recommended that the colonic evaluation is done by conventional colonoscopy (CC) because of the high sensitivity, direct visualization of the mucosa, and therapeutic ability for resecting polyps. However, inadequate colonic evaluation is often seen because of lack of resources, acute surgery, poor bowel preparation, adhesions, pain, and most importantly, cancer stenosis making a full 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 PREOP colonic evaluation. Furthermore, to evaluate the quality of perioperative clean-colonic evaluation (PCE) using either standard perioperative colonic evaluation versus magnetic resonance colonography (MRC) in patients with rectal cancer.
Materials and methods
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Patients
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Patient Bowel Preparation
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MR Imaging
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Data Analyses
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Conventional Colonoscopy
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Complete Colonic Evaluation
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Results
Patient Population
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Evaluation
Colon Evaluation
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Table 1
Modality Used for Preoperative Colonic Evaluation
Frequency Percent Group A Rectoscopy 1 3.6 Sigmoidoscopy 12 42.9 Colonoscopy 11 39.3 Rectocopy due to stricture 2 7.1 Sigmoidoscopy due to stricture 3 10.7 Total 28 100.0 Group B Rectoscopy 2 7.1 Sigmoidoscopy 10 35.7 Colonoscopy 10 35.7 Rectoscopy due to stricture 3 10.7 Sigmoidoscopy due to stricture 3 10.7 Total 28 100.0
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MR Colonography
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Colonic Findings
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Discussion
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Acknowledgments
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