Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Postoperative Imaging Findings of Colorectal Surgery: A Pictorial Essay

대장 직장 수술의 수술 후 영상 소견들: 임상화보

  • Inkeon Yeo (Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University) ;
  • Myung-Won Yoo (Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University) ;
  • Seong Jin Park (Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University) ;
  • Sung Kyoung Moon (Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University)
  • 여인권 (경희대학교 의과대학 경희대학교병원 영상의학과) ;
  • 유명원 (경희대학교 의과대학 경희대학교병원 영상의학과) ;
  • 박성진 (경희대학교 의과대학 경희대학교병원 영상의학과) ;
  • 문성경 (경희대학교 의과대학 경희대학교병원 영상의학과)
  • Received : 2021.12.31
  • Accepted : 2023.12.20
  • Published : 2024.07.01
Download PDF
⟨ Previous Next ⟩

Abstract

Postoperative colorectal imaging studies play an important role in the detection of surgical complications and disease recurrence. In this pictorial essay, we briefly describe methods of surgery, imaging findings of their early and late complications, and postsurgical recurrence of cancer and inflammatory bowel disease.

대장과 직장 수술 후 영상 검사는 수술 후 생기는 합병증과 특정 질환의 재발을 발견하는 데 있어 중요한 역할을 한다. 이 임상화보에서는 개략적인 대장과 직장 수술 방법, 영상 기법, 수술 후 조기 및 후기 합병증의 특징적 영상 소견, 암 재발 또는 염증성 대장 질환의 특징적 영상 소견에 대해서 다룰 것이다.

Keywords

References

  1. Jeon Y, Park EJ, Baik SH. Robotic surgery for rectal cancer and cost-effectiveness. J Minim Invasive Surg 2019;22:139-149
  2. Tevis SE, Kennedy GD. Postoperative complications: looking forward to a safer future. Clin Colon Rectal Surg 2016;29:246-252
  3. Gandy RC, Berney CR. Safety of laparoscopic colorectal surgery in a low-volume setting: review of early and late outcome. Gastroenterol Res Pract 2014;2014:581523
  4. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome. Colorectal Dis 2009;11:354-364
  5. Heald RJ. The 'holy plane' of rectal surgery. J R Soc Med 1988;81:503-508
  6. MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet 1993;341:457-460
  7. Manegold P, Taukert J, Neeff H, Fichtner-Feigl S, Thomusch O. The minimum distal resection margin in rectal cancer surgery and its impact on local recurrence - a retrospective cohort analysis. Int J Surg 2019;69:77-83
  8. Song SH, Park JS, Choi GS, Seo AN, Park SY, Kim HJ, et al. Impact of the distal resection margin on local recurrence after neoadjuvant chemoradiation and rectal excision for locally advanced rectal cancer. Sci Rep 2021;11:22943
  9. Wood DE. National Comprehensive Cancer Network (NCCN) clinical practice guidelines for lung cancer screening. Thorac Surg Clin 2015;25:185-197
  10. Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 2020;25:1-42
  11. Varela C, Kim NK. Surgical treatment of low-lying rectal cancer: updates. Ann Coloproctol 2021;37:395-424
  12. Sabiston DC, Townsend CM, Beauchamp R, Evers B, Mattox K. Sabiston textbook of surgery: the biological basis of modern surgical practice. Philadelphia: Wb Saunders 2001
  13. Shackelford RT, Zuidema GD. Shackelford's surgery of the alimentary tract. 5th ed. Philadelphia: W.B Saunders 1991
  14. Scott-Conner CE, Kaiser AM, Nguyen NT, Sarpel U, Sugg SL. Chassin's operative strategy in general surgery: an expositive atlas. Cham: Springer Nature 2022
  15. Barbieux J, Plumereau F, Hamy A. Current indications for the Hartmann procedure. J Visc Surg 2016;153:31-38
  16. Kacey DJ. Surgical pitfalls: prevention and management. JAMA 2010;303:672-673
  17. Mariolis-Sapsakos T, Psathas G, Nikolouzakis TK, Laschos K, Triantopoulou C, Bonatsos G, et al. An anatomic anal sphincter-saving procedure for rectal cancers located at anorectal junction. World J Surg Oncol 2019;17:131
  18. Marr R, Birbeck K, Garvican J, Macklin CP, Tiffin NJ, Parsons WJ, et al. The modern abdominoperineal excision: the next challenge after total mesorectal excision. Ann Surg 2005;242:74-82
  19. Nagtegaal ID, van de Velde CJ, Marijnen CA, van Krieken JH, Quirke P. Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol 2005;23:9257-9264
  20. Serrano M, Biondo S. Abdominoperineal excision or extralevator abdominoperineal excision: which is the best oncological treatment? Ann Laparosc Endosc Surg 2018;3:33
  21. Dimitriou N, Michail O, Moris D, Griniatsos J. Low rectal cancer: sphincter preserving techniques-selection of patients, techniques and outcomes. World J Gastrointest Oncol 2015;7:55-70
  22. Althumairi AA, Gearhart SL. Local excision for early rectal cancer: transanal endoscopic microsurgery and beyond. J Gastrointest Oncol 2015;6:296-306
  23. Paty PB, Nash GM, Baron P, Zakowski M, Minsky BD, Blumberg D, et al. Long-term results of local excision for rectal cancer. Ann Surg 2002;236:522-529
  24. Cutting JE, Hallam SE, Thomas MG, Messenger DE. A systematic review of local excision followed by adjuvant therapy in early rectal cancer: are pT1 tumours the limit? Colorectal Dis 2018;20:854-863
  25. Lopez MJ, Monafo WW. Role of extended resection in the initial treatment of locally advanced colorectal carcinoma. Surgery 1993;113:365-372
  26. Lopez MJ, Standiford SB, Skibba JL. Total pelvic exenteration. A 50-year experience at the Ellis Fischel Cancer Center. Arch Surg 1994;129:390-395; discussion 395-396
  27. Rodriguwz-Bigas MA, Petrelli NJ. Pelvic exenteration and its modifications. Am J Surg 1996;171:293-301
  28. Wanebo HJ, Gaker DL, Whitehill R, Morgan RF, Constable WC. Pelvic recurrence of rectal cancer. Options for curative resection. Ann Surg 1987;205:482-495
  29. Pawlik TM, Skibber JM, Rodriguez-Bigas MA. Pelvic exenteration for advanced pelvic malignancies. Ann Surg Oncol 2006;13:612-623
  30. Scardapane A, Brindicci D, Fracella MR, Angelelli G. Post colon surgery complications: imaging findings. Eur J Radiol 2005;53:397-409
  31. Ramos-Andrade D, Andrade L, Ruivo C, Portilha MA, Caseiro-Alves F, Curvo-Semedo L. Imaging the postoperative patient: long-term complications of gastrointestinal surgery. Insights Imaging 2016;7:7-20
  32. Low G, Tho LM, Leen E, Wiebe E, Kakumanu S, McDonald AC, et al. The role of imaging in the pre-operative staging and post-operative follow-up of rectal cancer. Surgeon 2008;6:222-231
  33. Liu L, Herrinton LJ, Hornbrook MC, Wendel CS, Grant M, Krouse RS. Early and late complications among long-term colorectal cancer survivors with ostomy or anastomosis. Dis Colon Rectum 2010;53:200-212
  34. Tsujinaka S, Tan KY, Miyakura Y, Fukano R, Oshima M, Konishi F, et al. Current management of intestinal stomas and their complications. J Anus Rectum Colon 2020;4:25-33
  35. Pak H, Maghsoudi LH, Soltanian A, Gholami F. Surgical complications in colorectal cancer patients. Ann Med Surg (Lond) 2020;55:13-18
  36. Zissin R, Gayer G. Postoperative anatomic and pathologic findings at CT following colonic resection. Semin Ultrasound CT MR 2004;25:222-238
  37. Weinstein S, Osei-Bonsu S, Aslam R, Yee J. Multidetector CT of the postoperative colon: review of normal appearances and common complications. Radiographics 2013;33:515-532
  38. van Helsdingen CP, Jongen AC, de Jonge WJ, Bouvy ND, Derikx JP. Consensus on the definition of colorectal anastomotic leakage: a modified Delphi study. World J Gastroenterol 2020;26:3293-3303
  39. Li YW, Lian P, Huang B, Zheng HT, Wang MH, Gu WL, et al. Very early colorectal anastomotic leakage within 5 post-operative days: a more severe subtype needs relaparatomy. Sci Rep 2017;7:39936
  40. Daams F, Luyer M, Lange JF. Colorectal anastomotic leakage: aspects of prevention, detection and treatment. World J Gastroenterol 2013;19:2293-2297
  41. Chambers WM, Mortensen NJ. Postoperative leakage and abscess formation after colorectal surgery. Best Pract Res Clin Gastroenterol 2004;18:865-880
  42. Khan AA, Wheeler JM, Cunningham C, George B, Kettlewell M, Mortensen NJ. The management and outcome of anastomotic leaks in colorectal surgery. Colorectal Dis 2008;10:587-592
  43. Samji KB, Kielar AZ, Connolly M, Fasih N, Doherty G, Chung A, et al. Anastomotic leaks after small- and large-bowel surgery: diagnostic performance of CT and the importance of intraluminal contrast administration. AJR Am J Roentgenol 2018;210:1259-1265
  44. Habib K, Gupta A, White D, Mazari FA, Wilson TR. Utility of contrast enema to assess anastomotic integrity and the natural history of radiological leaks after low rectal surgery: systematic review and meta-analysis. Int J Colorectal Dis 2015;30:1007-1014
  45. Power N, Atri M, Ryan S, Haddad R, Smith A. CT assessment of anastomotic bowel leak. Clin Radiol 2007;62:37-42
  46. Ferrara M, Kann BR. Urological injuries during colorectal surgery. Clin Colon Rectal Surg 2019;32:196-203
  47. Esparaz AM, Pearl JA, Herts BR, LeBlanc J, Kapoor B. Iatrogenic urinary tract injuries: etiology, diagnosis, and management. Semin Intervent Radiol 2015;32:195-208
  48. Ochiai K, Kaneko M, Nozawa H, Kawai K, Hata K, Tanaka T, et al. Incidence of and risk factors for lymphocele formation after lateral pelvic lymph node dissection for rectal cancer: a retrospective study. Colorectal Dis 2020;22:161-169
  49. Lv S, Wang Q, Zhao W, Han L, Wang Q, Batchu N, et al. A review of the postoperative lymphatic leakage. Oncotarget 2017;8:69062-69075
  50. Yang DM, Jung DH, Kim H, Kang JH, Kim SH, Kim JH, et al. Retroperitoneal cystic masses: CT, clinical, and pathologic findings and literature review. Radiographics 2004;24:1353-1365
  51. Ghahremani GG, Jimenez MA, Rosenfeld M, Rochester D. CT diagnosis of occult incisional hernias. AJR Am J Roentgenol 1987;148:139-142
  52. Stylinski R, Alzubedi A, Rudzki S. Parastomal hernia - current knowledge and treatment. Wideochir Inne Tech Maloinwazyjne 2018;13:1-8
  53. Janes A, Weisby L, Israelsson LA. Parastomal hernia: clinical and radiological definitions. Hernia 2011;15:189-192
  54. Kim CH, Joo JK, Kim HR, Kim YJ. The incidence and risk of early postoperative small bowel obstruction after laparoscopic resection for colorectal cancer. J Laparoendosc Adv Surg Tech A 2014;24:543-549
  55. Paulson EK, Thompson WM. Review of small-bowel obstruction: the diagnosis and when to worry. Radiology 2015;275:332-342
  56. Silva AC, Pimenta M, Guimaraes LS. Small bowel obstruction: what to look for. Radiographics 2009;29:423-439
  57. Rha SE, Ha HK, Lee SH, Kim JH, Kim JK, Kim JH, et al. CT and MR imaging findings of bowel ischemia from various primary causes. Radiographics 2000;20:29-42
  58. Hayakawa K, Tanikake M, Yoshida S, Yamamoto A, Yamamoto E, Morimoto T. CT findings of small bowel strangulation: the importance of contrast enhancement. Emerg Radiol 2013;20:3-9
  59. Pallan A, Dedelaite M, Mirajkar N, Newman PA, Plowright J, Ashraf S. Postoperative complications of colorectal cancer. Clin Radiol 2021;76:896-907
  60. VanBuren WM, Lightner AL, Kim ST, Sheedy SP, Woolever MC, Menias CO, et al. Imaging and surgical management of anorectal vaginal fistulas. Radiographics 2018;38:1385-1401
  61. Tonolini M. Elucidating vaginal fistulas on CT and MRI. Insights Imaging 2019;10:123
  62. Hiranyakas A, Da Silva G, Denoya P, Shawki S, Wexner SD. Colorectal anastomotic stricture: is it associated with inadequate colonic mobilization? Tech Coloproctol 2013;17:371-375
  63. Picazo-Ferrera K, Jaurrieta-Rico C, Manzano-Robleda M, Alonso-Larraga J, de la Mora-Levy J, Hernandez-Guerrero A, et al. Risk factors and endoscopic treatment for anastomotic stricture after resection in patients with colorectal cancer. Rev Gastroenterol Mex (Engl Ed) 2021;86:44-50
  64. Broder JC, Tkacz JN, Anderson SW, Soto JA, Gupta A. Ileal pouch-anal anastomosis surgery: imaging and intervention for post-operative complications. Radiographics 2010;30:221-233
  65. Martel P, Betton PO, Gallot D, Malafosse M. Crohn's colitis: experience with segmental resections; results in a series of 84 patients. J Am Coll Surg 2002;194:448-453
  66. Lapidus A, Bernell O, Hellers G, Lofberg R. Clinical course of colorectal Crohn's disease: a 35-year follow-up study of 507 patients. Gastroenterology 1998;114:1151-1160
  67. Penna C, Dozois R, Tremaine W, Sandborn W, LaRusso N, Schleck C, et al. Pouchitis after ileal pouch-anal anastomosis for ulcerative colitis occurs with increased frequency in patients with associated primary sclerosing cholangitis. Gut 1996;38:234-239
  68. Stahlberg D, Gullberg K, Liljeqvist L, Hellers G, Lofberg R. Pouchitis following pelvic pouch operation for ulcerative colitis. Incidence, cumulative risk, and risk factors. Dis Colon Rectum 1996;39:1012-1018
  69. Reber JD, Barlow JM, Lightner AL, Sheedy SP, Bruining DH, Menias CO, et al. J pouch: imaging findings, surgical variations, natural history, and common complications. Radiographics 2018;38:1073-1088
  70. Hansdotter P, Scherman P, Petersen SH, Mikalonis M, Holmberg E, Rizell M, et al. Patterns and resectability of colorectal cancer recurrences: outcome study within the COLOFOL trial. BJS Open 2021;5:zrab067
  71. Freeny PC, Marks WM, Ryan JA, Bolen JW. Colorectal carcinoma evaluation with CT: preoperative staging and detection of postoperative recurrence. Radiology 1986;158:347-353
  72. Colosio A, Fornes P, Soyer P, Lewin M, Loock M, Hoeffel C. Local colorectal cancer recurrence: pelvic MRI evaluation. Abdom Imaging 2013;38:72-81
  73. Georgiou PA, Tekkis PP, Brown G. Pelvic colorectal recurrence: crucial role of radiologists in oncologic and surgical treatment options. Cancer Imaging 2011;11:S103-S111