CT prognostic signs of postoperative complications in emergency surgery for acute obstructive colonic cancer.

Abstract

To identify CT prognostic signs of poor outcomes in acute obstructive colonic cancer (AOCC). Demographic,clinical, laboratory, radiological and surgical dataof65consecutive patients with AOCC who underwent emergency surgery were analyzed. CT examswere 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 cecalpneumatosis. PostOperative complications (PO), according to the Clavien-Dindo classification, were analyzed. 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 ≥ 9cm 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. 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 toidentify 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 ≥ 9cm represented the critical diameter beyond which perforation occurred in > 84% of patients.