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首页> 美国卫生研究院文献>World Journal of Gastroenterology >CT colonography in the diagnosis and management of colorectal cancer: Emphasis on pre- and post-surgical evaluation
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CT colonography in the diagnosis and management of colorectal cancer: Emphasis on pre- and post-surgical evaluation

机译：CT结肠造影在大肠癌诊断和治疗中的应用：重视术前和术后评估

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This article addresses the use of computed tomographic colonography (CTC) for the diagnosis and management of colorectal cancer, focusing on presurgical evaluation of the colon proximal to an occlusive cancer and surveillance after cancer resection surgery. The key evidences accumulated in the literature and future work needed are summarized. CTC is a technically robust and the most practical method to evaluate the colon proximal to an occlusive cancer, which prevents colonoscopic examination past the occlusion, either before or after metallic stent placement. The high sensitivity of CTC for detecting cancers and advanced adenomas in the proximal colon can help prevent additional surgical procedures in patients showing negative results. However, the accuracy of CTC for distinguishing intramural cancers from adenomas is low, and the technique is limited in guiding management when a medium-sized lesion that do not show invasive features such as pericolic extension or nodal metastasis is found in the proximal colon. A maximal diameter ≥ 15 mm has been proposed as a criterion for surgical removal of proximal lesions. However, this needs to be verified in a larger cohort. In addition, the influence of presurgical CTC results on the current post-cancer resection colonic surveillance timeline remains to be determined. CTC can be readily added to the routine abdominopelvic CT in the form of contrast-enhanced CTC, which can serve as an effective stand-alone tool for post-cancer resection surveillance of both the colorectum and extracolonic organs. Although the accuracy of CTC has been demonstrated, its role in the current colonoscopy-based postoperative colonic surveillance protocols remains to be determined. Readers of CTC also need to be knowledgeable on the colonic lesions that are unique to the postoperative colon.
机译：本文介绍了计算机断层摄影结肠造影（CTC）在大肠癌诊断和治疗中的应用，重点是对闭塞性癌近端结肠的术前评估和癌切除术后的监视。总结了文献中积累的关键证据和未来需要的工作。 CTC是评估闭塞癌近端结肠的技术稳健且最实用的方法，可防止在放置金属支架之前或之后进行结肠镜检查以检查闭塞后的结肠。 CTC对近端结肠癌和晚期腺瘤的检测具有很高的敏感性，可以帮助预防表现出阴性结果的患者进行额外的手术。但是，CTC区分壁内癌与腺瘤的准确性低，当在近端结肠中发现不显示侵袭性特征（如周长性扩张或淋巴结转移）的中型病变时，该技术在指导治疗方面受到限制。已经提出最大直径≥15 mm作为外科切除近端病变的标准。但是，这需要在更大的队列中进行验证。此外，术前CTC结果对当前癌症切除后结肠监测时间线的影响尚待确定。 CTC可以以增强造影剂的形式轻易地添加到常规的腹腔盆腔CT中，它可以作为有效的独立工具，用于对结肠直肠和结肠外器官进行癌后切除监测。尽管已经证明了CTC的准确性，但其在当前基于结肠镜检查的术后结肠监测方案中的作用仍有待确定。 CTC的读者还需要了解术后结肠特有的结肠病变。

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