Feasibility and Safety of Intraoperative Colonoscopy after Segmental Colectomy and Primary Anastomosis

Patients presenting with near-obstructing colon lesions requiring segmental colectomy may benefit from intraoperative colonoscopy (IOC) after primary anastomosis for a more timely and accurate diagnosis of synchronous lesions. The aim of this study is to demonstrate the feasibility and safety of this technique. A retrospective cohort study of patients undergoing single-stage segmental colectomy and anastomosis at a single tertiary care institution from 2011 to 2013 was performed. One Hundred and sixty-eight consecutive patients underwent segmental colectomy and primary anastomosis of which 78 (46%) were unable to receive preoperative colonoscopy (POC) because of near-obstructing lesions and received IOC after the anastomosis. IOC detected synchronous adenomatous polyps in 24.4 per cent, diverticular disease in 19 per cent, and colitis/proctitis in 2.5 per cent. The IOC group was not significantly different from the POC group with regard to overall morbidity (31% vs 39% P = 0.45), anastomotic leakage (1.3% vs 0%, P = 0.46), or wound infection (5.1% vs 1.1%, P = 0.18). Operation time was 19 minutes longer in the intra-operative group, but overall length of hospital stay was not significantly different (6.4 ± 2.9 days vs 7.3 ± 4.6 days). In patients unable to receive POC because of partial obstruction, IOC after primary anastomosis is both feasible and safe for detecting proximal synchronous lesions.

CT and PET-CT for detection of synchronous lesion in patients with colorectal cancer obstruction.

581 Background: Full preoperative colonic evaluation is recommended to exclude synchronous lesions. In patients with occlusive colorectal cancers, preoperative colonoscopy may not be possible because of narrowing of the lumen. After colonic stent placement, colonoscopy to the proximal part of the obstruction is feasible. However, a complete preoperative colonoscopy was not possible in some cases. The aim of our study was to evaluate the efficacy of preoperative CT and PET-CT for detection of synchronous neoplasms compared with colonoscopy in colorectal cancer obstruction patients who underwent colonic stent. Methods: A retrospective chart review of 205 patients who performed endoscopic colon stent placement for acute malignant colorectal obstruction between January 2010 and October 2015. To find synchronous cancer and other precancerous lesion, we reviewed CT, PET-CT finding and colonoscopic image. The results of CT and PET-CT were compared with the finding of the colonoscopy, which was remains the most reliable method for the detection of synchronous neoplasm. Results: Of the 205 patients with colonic stent placement, 115 patients underwent CT, PET-CT and preoperative colonoscopy passing through the colonic stent. On preoperative colonoscopy, 3 of 115 patients (2.7%) had synchronous cancers and 11 of 115 patients (9.6%) had large polyps (tubulovillous adenoma with high grade dysplasia). On CT and PET-CT, all synchronous lesions were detected. But among the eleven polyps, nine polyps had not been seen at CT and PET-CT. Conclusions: Our study indicates that CT and PET-CT were feasible and useful method of evaluating the entire colon to exclude synchronous colonic lesions in patients with acute colon obstruction after an effective stent placement. But colonoscopy should be performed shortly to find out precancerous lesion especially adenoma with high grade dysplasia.