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World J Gastroenterol. Feb 28, 2014; 20(8): 2014-2022
Published online Feb 28, 2014. doi: 10.3748/wjg.v20.i8.2014
CT colonography in the diagnosis and management of colorectal cancer: Emphasis on pre- and post-surgical evaluation
Nurhee Hong, Seong Ho Park
Nurhee Hong, Seong Ho Park, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, South Korea
Author contributions: Hong N and Park SH designed and performed research; Hong N and Park SH contributed new reagents or analytic tools, analyzed data and wrote the paper.
Supported by Technology Innovation Program, No.10043072, funded by the Ministry of Trade, Industry and Energy (MOTIE), South Korea
Correspondence to: Seong Ho Park, MD, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, South Korea. parksh.radiology@gmail.com
Telephone: +82-2-30105984 Fax: +82-2-4764719
Received: September 23, 2013
Revised: December 9, 2013
Accepted: January 14, 2014
Published online: February 28, 2014
Processing time: 155 Days and 13.4 Hours
Abstract

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.

Keywords: Computed tomographic colonography; Colonic cancer; Rectal cancer; Surgery; Colonoscopy

Core tip: Computed tomographic colonography (CTC) is technically robust and the most practical method to evaluate the colon proximal to an occlusive cancer either before or after metallic stent placement. Contrast-enhanced CTC may serve as an effective stand-alone tool for post-cancer resection surveillance of both the colorectum and extracolonic organs. However, several issues discussed in this article should be addressed further and clarified.