Review of Computed Tomographic Colonography from a Surgeon’s Perspective

Abstract

New research has addressed many of the early concerns of computed tomographic colonography (CTC) and these studies are now beginning to shape clinical practices. A review of the literature demonstrates that the sensitivity of CTC in screening for large polyps (>/= 1cm) or cancers in the large intestine is as high as that of conventional optical colonoscopy, however, the sensitivity decreases with the diameter of the polyp. Despite this, CTC is well tolerated, more acceptable to patients than optical colonoscopy and therefore may improve colorectal cancer screening compliance. This review not only describes the diagnostic accuracy and sensitivity of CTC, and the evolving role of CTC as a primary colon cancer screening option, but also the recent studies that have demonstrated the additional value of CTC utilization for practicing clinicians.

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“…VC can be applied in conjunction with a full OC to confirm diagnosis and staging with a low risk of complications compared to OC alone. Postprocedure perforation in VC and OC amounts only to 0.03% and 0.009%, respectively [7]. VC is preferred in comorbid patients, too.…”

“…It allows the staging of CRC patients. A combination of early detection and adenoma removal remains the best method for reduction of CRC incidence and mortality rates [7].…”

“…The interest in VC has been renewed after a publication in the New England Journal of Medicine in 2015 [6][7][8]. This method warrants an almost 100% diagnostic success in detecting CRC and colon polyps.…”

“…Failure to identify a synchronous cancer before surgery results in curative resection failure and is associated with the added morbidity and mortality of a second surgical procedure as well as with an invasive, potentially metastasizing cancer in the remaining colon [16]. CTC is well-tolerated and more acceptable to patients than OC and improves CRC screening compliance [7].…”

Computed tomography colonography: a retrospective analysis of outcomes of 2 years experience in a district general hospital

“…However, in 1994, Vining et al suggested CTC, an investigation comprising oral contrast and air insufflation per rectum with advanced radiological technology allowing two‐ and three‐dimensional reconstruction of the colon and rectum; with a relatively low‐risk profile. Although it does not offer the opportunity of biopsy or therapeutic procedures, it is a less invasive and safer investigation for certain patients groups; including frail patients or those in whom OC has failed . Colorectal cancer is the fourth most common cause of cancer in the UK, but the second commonest cause of cancer death .…”