Computed Tomography Colonography Angiography (CTC-A) prior to colectomy for cancer: A new tool for surgeons - 13/04/22
, G. Manceau c, A. Lansier a, G. Rahmi d, J. Taïeb e, M. Karoui cBienvenue sur EM-consulte, la référence des professionnels de santé.
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Highlights |
• | CTC-A consists of abdomino-pelvic CT with IV contrast injection that requires prior colonic preparation, colonic distension by CO2, and double tagging of residual stool with oral contrast agents. |
• | CTC-A is a reproducible and well-tolerated examination with a very low risk of perforation (0.001%). |
• | Compared to standard CT with IV contrast, CTC-A assesses the morphology of the entire colon and makes it possible to establish the precise location of the tumor, even in the case of dolichocolon, and to search for synchronous lesions, particularly when the colonoscope cannot traverse the tumor-bearing segment. It has a sensitivity and specificity of more than 90%. |
• | CTC-A makes it possible to define the parietal extension of the tumor using sections perpendicular to the axis of the distended intestinal lumen and to discuss the indications for neo-adjuvant chemotherapy in the event of a locally advanced tumor. |
• | Compared to standard thoraco-abdomino-pelvic (TAP) CT with IV contrast, CTC-A with image fusion also allows simultaneous vascular mapping of the colon at the tumor site and can help the surgeon to plan the colectomy (extent of the colectomy, variations in vascular anatomy, lymph node dissection). |
Summary |
The pre-operative work-up for non-metastatic colon cancer includes colonoscopy and thoraco-abdomino-pelvic computed tomography (CT) with intravenous (IV) contrast. Colonoscopic determination of the anatomical location of the tumor may be erroneous, particularly with a long redundant colon (dolichocolon), and the search for synchronous colon neoplasms is limited when the endoscope cannot traverse the tumor-bearing segment. While computed tomography colonography angiography (CTC-A) makes it possible to assess distant tumor metastasis, it remains limited for the assessment of loco-regional extension. CTC-A requires specific colonic preparation, controlled colonic insufflation with CO2, and an injection of IV contrast. CTC-A provides a 3-D view of the overall morphology of the colon and precisely localizes the site of the colonic tumor. Merging the images of the colon with those of mesenteric and colonic vessels provides a representation of anatomical vascular variations. This information could help the surgeon to better plan the colectomy. The use of two-dimensional images of CTC-A with sections perpendicular to the major axis of the tumor-bearing colonic segment can provide precise information on the degree of parietal extension and be useful in evaluating the value of neo-adjuvant chemotherapy.
Le texte complet de cet article est disponible en PDF.Keywords : Virtual colonoscopy, Three-dimensional angio CT colonography, Colon cancer, Colectomy, Pre-operative workup
Plan
Vol 159 - N° 2
P. 136-143 - avril 2022 Retour au numéro
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