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Contrast-enhanced abdominal computed tomography to evaluate anastomotic integrity before ileostomy closure in postoperative colorectal cancer patients

 Yeun-Yoon Kim  ;  Nieun Seo  ;  Kang Young Lee  ;  Nam Kyu Kim  ;  Joon Seok Lim 
 ABDOMINAL RADIOLOGY, Vol.46(9) : 4130-4137, 2021-09 
Journal Title
Issue Date
Anastomosis, Surgical ; Colorectal Neoplasms* / diagnostic imaging ; Colorectal Neoplasms* / surgery ; Humans ; Ileostomy* ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed
Anastomotic leakage ; Colorectal cancer ; Computed tomography ; Ileostomy
Purpose: To investigate the usefulness of contrast-enhanced abdominal computed tomography (CECT) to predict clinically significant anastomotic leakage (CSAL) in patients who received colorectal cancer surgery with diverting ileostomy.

Methods: In this retrospective cohort study, patients who underwent colorectal cancer surgery with diverting ileostomy from January 2014 to May 2018 and postoperative CECT were included. The performance of significant CECT features, identified using multivariable logistic regression, to predict CSAL was calculated. In subgroup analysis, the areas under the receiver operating characteristic curve (AUROCs) were compared between CECT and water-soluble contrast enema (WSCE) using DeLong's method.

Results: Of 325 patients (median age, 58 years; 213 men), CECT was routinely performed to evaluate cancer status in 307 (94.5%), and CSAL was observed in 28 (8.6%). After multivariable adjustment, anastomotic mural defect (odds ratio [OR] 5.24; 95% confidence interval [CI] 1.77-15.51; p = 0.003), perianastomotic air (OR 7.28; 95% CI 1.82-29.17; p = 0.007) and ischemic colitis (OR 3.30; 95% CI 1.13-9.61; p = 0.029) were significantly associated with CSAL. The sensitivity, specificity, accuracy, and positive and negative predictive values of significant CECT features were 60.7%, 88.2%, 85.9%, 32.7%, and 96.0%, respectively. In subgroup analysis of 144 patients, the AUROC using significant CECT features (optimal sensitivity/specificity, 50.0%/90.4%) was comparable to that using WSCE (optimal sensitivity/specificity, 12.5%/97.8%) to predict CSAL (0.704 vs. 0.552, p = 0.085).

Conclusion: CECT performed after colorectal cancer surgery may be useful to assess anastomotic integrity before ileostomy closure, especially to negatively predict CSAL. In the presence of anastomotic mural defect, perianastomotic air, or ischemic colitis, WSCE may be recommended to exclude CSAL.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Kim, Yeun-Yoon(김연윤) ORCID logo https://orcid.org/0000-0003-2018-5332
Seo, Nieun(서니은) ORCID logo https://orcid.org/0000-0001-8745-6454
Lee, Kang Young(이강영)
Lim, Joon Seok(임준석) ORCID logo https://orcid.org/0000-0002-0334-5042
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