Routine preoperative abdominal computed tomography in colon cancer : a utility study

Background: There is currently little proven utility for the preoperative scanning of intraperitoneal colonic cancer using computerized tomography (CT). A prospective study was conducted where CT scanning was preoperatively incorporated into the management algorithm to ascertain its role in patient management. Methods: Thoracoabdominal CT scanning was performed in both the elective and emergency settings in an unselected group of 73 patients referred to a coloproctology unit established over the last 30 months at the Queen Elizabeth Hospital, Barbados with in-hospital and electronic correlation of the CT and operative findings to determine the influence that the preoperative CT scan made on surgical decision making. Results: Unexpected additional pathology was found in 6.8% of patients with a sensitivity for the detection of visceral metastatic disease of 91.7%. The preoperative scan was deemed to be of clinical value in 24.7% of cases and to definitively alter surgical management in 13.7% of patients. These alterations in management included several types of multivisceral resections, the need for ureteric stenting or reimplantation, the utilization of stomas alone and the avoidance of resection in known metastatic disease. Conclusion: Preoperative CT scanning of intraperitoneal colonic cancer adds important technical information to the conduct of the surgery and alters therapy in a selected patient group