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.

中文翻译：

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急性梗阻性结肠癌急诊手术术后并发症的CT预后征象

目的

确定急性梗阻性结肠癌 (AOCC) 不良预后的 CT 预后征兆。

方法

对 65 名连续接受紧急手术的 AOCC 患者的人口统计学、临床、实验室、放射学和手术数据进行了分析。检查 CT 检查以评估肿瘤近端的盲肠直径、上行直径、横行直径、下行直径和乙状结肠直径；结肠段的 CD/L1-VD 比值、回盲瓣的节制、小肠过度扩张、小肠粪便征和盲肠积气的存在。根据 Clavien-Dindo 分类，对术后并发症 (PO) 进行了分析。

结果

性别、年龄和肿瘤位置不是并发症的预测因素。在实验室检查中，CRP 是 PO 最重要的预测值（OR 8.23）。盲肠扩张≥9cm为临界直径，超过该直径则手术中发现穿孔和盲肠坏死。 < 50% 的患者 CT 发现盲肠积气与手术时盲肠坏死相关。术前横结肠CD/L1-VD比值≥1.43和降结肠CD/L1-VD比值≥1.31与PO（≥III-V级）的发生相关。 18/65 名患者发生 PO（≥ III-V 级）。

结论

AOCC急诊手术术后并发症与年龄、性别、肿瘤部位无关。术前PCR值（≥2.17）可预测术后并发症的发生。 CT 是一种有效的诊断工具，可识别并发症风险较高的患者：CD/L1-VD 比值的临界值分别为 1.43（横向）和 1.31（下降），预测主要并发症（≥ III-V 级）和盲肠扩张≥9cm代表临界直径，超过该直径则>84%的患者发生穿孔。