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Open Access Research article

The strengths and limitations of routine staging before treatment with abdominal CT in colorectal cancer

Irene Grossmann12*, Joost M Klaase2, Johannes KA Avenarius3, Ignace HJT de Hingh4, Walter JB Mastboom2 and Theo Wiggers1

Author Affiliations

1 Department of Surgery, University Medical Center Groningen, (Hanzeplein 1), Groningen, (9713 GZ), the Netherlands

2 Department of Surgery, Medical Spectrum Twente, (Haaksbergerstraat 55), Enschede (7513 ER), the Netherlands

3 Department of Radiology, Medical Spectrum Twente, (Haaksbergerstraat 55), Enschede, (7513 ER), the Netherlands

4 Department of Surgery, Catharina Hospital, (Michelangelolaan 2), Eindhoven, (5623 EJ), the Netherlands

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BMC Cancer 2011, 11:433  doi:10.1186/1471-2407-11-433

Published: 7 October 2011

Abstract

Background

Advanced colorectal cancer (CRC), either locally advanced, metastasized (mCRC) or both, is present in a relevant proportion of patients. The chances on curation of advanced CRC are continuously improving with modern multi-modality treatment options. For incurable CRC the focus lies on palliation of symptoms, which is not necessarily a resection of the primary tumor. Both situations motivate adequate staging before treatment in CRC. This prospective observational study evaluates the outcomes after the introduction of routine staging with abdominal CT before treatment.

Methods

In a prospective observational study of 612 consecutive patients (2007-2009), the ability of abdominal CT to find liver metastases (LM), peritoneal carcinomatosis (PC) and T4 stage in colon cancer (CC) was analysed.

Results

Advanced CRC was present in 58% of patients, mCRC in 31%. The ability to find LM was excellent (99%), cT4 stage CC good (86%) and PC poor (33%). In the group of surgical patients with emergency presentations, the incidences of both mCRC (51%) and locally advanced colon cancer (LACC) (69%) were higher than in the elective group (20% and 26% respectively). Staging tended to be omitted more often in the emergency group (35% versus 12% in elective surgery).

Conclusions

The strengths of staging with abdominal CT are to find LM and LACC, however it fails in diagnosing PC. On grounds of the incidence of advanced CRC, staging is warranted in patients with emergency presentations as well.