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ABSTRACT: AIM: Doppler guided haemorrhoidal artery ligation (DGHL) has experienced wider uptake and has recently received National Institute for Health and Clinical Excellence (NICE) approval in the UK. A systematic review of the literature was conducted to assess its safety and efficacy. METHOD: This review was conducted in keeping with PRISMA guidelines. MEDLINE, EMBASE, Google Scholar and Cochrane Library databases were searched. Studies describing DGHL as a primary procedure and reporting clinical outcome were considered. Primary endpoints were recurrence and post-operative pain. Secondary endpoints included operation time, complications and reintervention rates. Studies were scored for quality with either Jadad score or NICE scoring guidelines. RESULTS: 28 studies including 2904 patients were included in the final analysis, . They were of poor overall quality. Recurrence ranged between 3 - 60% (pooled recurrence rate 17.5%), with the highest rates for grade IV haemorrhoids. Post-operative analgesia was required in 0-38% patients. Overall post-operative complication rates were low, with an overall bleeding rate 5% and an overall reintervention rate of 6.4%. The operation time ranged from 19-35 minutes. CONCLUSION: DGHL is safe and efficacious with a low level of post-operative pain. It can be safely considered for primary treatment of grade II and III haemorrhoids. © 2013 The Authors. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.
Colorectal Disease 03/2013; · 2.93 Impact Factor
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ABSTRACT: BACKGROUND: This study aimed to describe national intermediate-term admission rates for incisional hernia or clinically apparent adhesions following colorectal surgery, and to compare rates following laparoscopic and open approaches. METHODS: Patients undergoing primary colorectal resection between 2002 and 2008 were included from the Hospital Episode Statistics database. Subsequent inpatient admissions were extracted for up to 3 years after the initial operation or to the end of the study period. Outcomes examined were admissions with a diagnosis of, or operative interventions for, incisional hernia or adhesions. RESULTS: A total of 187 148 patients were included between 2002 and 2008, with median follow-up of 31·8 (interquartile range 13·1-35·3) months. Some 8885 (4·7 per cent) of these patients were admitted with a diagnosis of, or underwent a repair of, an incisional hernia. In multiple regression analysis, use of laparoscopy was not a predictor of operative intervention for incisional hernia (odds ratio 1·09, 95 per cent confidence interval (c.i.) 0·99 to 1·21; P = 0·083). Some 15 125 (8·1 per cent) of the patients were admitted with a diagnosis of adhesions or had a procedure for division of adhesions. Overall, 3·5 per cent (6637 of 187 148) of patients underwent adhesiolysis. Patients selected for a laparoscopic procedure had lower rates of admission for adhesions (6·3 per cent (692 of 11 013) for laparoscopic versus 8·2 per cent (14 433 of 176 135) for open surgery; P < 0·001) and reintervention for adhesions (2·8 per cent (305 of 11 013) versus 3·6 per cent (6325 of 176 135) respectively; P < 0·001) than those undergoing an open procedure. In multiple regression analysis, patients selected for a laparoscopic procedure had lower subsequent intervention rates for adhesions (odds ratio 0·80, 95 per cent c.i. 0·71 to 0·90; P < 0·001). DISCUSSION: Patients undergoing colorectal resection who are selected for the laparoscopic approach have a lower risk of developing clinically significant adhesions. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
British Journal of Surgery 11/2012; · 4.61 Impact Factor
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British Journal of Surgery 11/2012; · 4.61 Impact Factor
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ABSTRACT: OBJECTIVE: Procedural outcomes can be used to assess the performance of specialists and trainees. This article establishes a systematic evidence base for the safety of training in the operating theatre. It also explores the possibility of using early, intermediate and late procedural outcomes of cardiac surgical operations to evaluate the performance of the clinicians and the healthcare system. METHODS: Medline, EMBASE and PsycINFO databases were searched. Comparative studies evaluating quality indicators of cardiac surgical procedures (coronary artery bypass grafting (CABG) and valve surgery) were included. Guidelines from the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) were used. RESULTS: Fourteen studies met the inclusion criteria. For CABG, meta-analysis of outcomes did not show any significant differences between the technical and non-technical skills of trainees versus specialists apart from bypass time (less for specialists) and intensive care unit (ICU) length of stay (less for trainees). Studies reporting outcomes on valve surgery also did not report any statistically significant differences amongst the outcomes. CONCLUSION: This systematic review did not discern any significant differences between the procedural outcomes of trainees and specialists, which indicates that trainees are safe to operate under senior supervision. In addition, this article recommends that various procedural outcomes can be used to evaluate the performance of clinicians and healthcare systems. Prospective studies need to be performed, taking into account the specific contribution of trainees and specialists during the procedure. This will give a clearer indication of safety and performance of trainees and specialists in the operating theatre.
Perfusion 09/2012; · 0.92 Impact Factor
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ABSTRACT: BACKGROUND: NOTES is advancing at a rapid pace with large registries of human applications and increasing evidence to support
safety and efficacy. We have however arrived at a stage in the development of the technique where many conceptual applications
are not supported by available technology to ensure safe implementation. METHODS: The data presented in this editorial are
based on the views of the authors and reviews of the literature which have been conducted using PubMed, a search tool of the
National Library of Medicine and the national institute of Health, including the MEDLINE database and the Cochrane library
until the 1st of February 2011. RESULTS: This editorial reviews the technological challenges that must be overcome and novel
solutions are discussed. CONCLUSIONS: For NOTES to realise its full potential, surgeons have to wait for technology to catch
up with ideological innovation before embarking on more complex procedures than the hybrid transvaginal feasibility studies
currently taking place.
KeywordsNatural orifice translumenal endoscopic surgery–Review–Innovation–NOTES–Technology
European Surgery 04/2012; 43(3):158-161. · 0.28 Impact Factor
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ABSTRACT: Background“Massed” and “distributed” practice are important concepts in the acquisition of fine motor skills, and may be important in
training in procedural skills.
MethodsA total of 41 novice subjects were recruited and randomized to three groups to receive training on the MIST VR surgical trainer.
There were 14 subjects in each of groups A and B and 13 subjects in group C. Training comprised 20 min of massed practice
for group A, 20 min of distributed practice in 5 min blocks for group B, and 15 min of distributed practice in 5-min blocks
for group C. Following the training period, all groups had a 5-min rest period, followed by a 5-min retention test. Comparisons
were made between groups A and B, and groups A and C.
ResultsThere was a statistically significant difference between groups A and B (p= 0.023) on the retention test, with group B performing better. The increment between the groups was 19% for the overall score
on MIST VR. There were also significant differences in the time taken to complete the task during the training phase (p=0.023, training blocks 3 and 4). Graphical representation suggests no effect between groups A and C, and statistical analysis
confirms that the observed difference in median score is not significant.
ConclusionThis study demonstrates a benefit for distributed practice over massed practice in learning laparoscopic surgical skills on
the MIST VR surgical trainer. This finding has potential implications for skills training in all areas of medicine.
Surgical Endoscopy 04/2012; 16(6):957-961. · 4.01 Impact Factor
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ABSTRACT: Sleep deprivation affects surgical performance and has the potential to endanger patient safety. Pharmacological stimulants may counter this consequence of long working hours. This study aimed to investigate whether commonly available stimulants can counter the effects of fatigue on technical and neurocognitive skill.
This was a single-blind crossover study of surgical novices trained to proficiency on the Minimally Invasive Surgical Trainer-Virtual Reality laparoscopic simulator. Participants were acutely sleep-deprived three times each, followed by administration of either placebo, 150 mg caffeine, or 150 mg caffeine combined with 2 g taurine before simulated laparoscopy. Outcome measures were: laparoscopic psychomotor skill, cognitive performance and the Stanford Sleepiness Scale (range 1-7). Rested baselines were gathered following completion of test sessions.
Baseline performance was recorded for 18 participants in the rested state. Sleep-deprived participants receiving the placebo took longer (median 41 versus 35 s; P = 0·016), were less economical with movement (3·25 versus 2·95 m; P = 0·016) and made more errors (66 versus 59; P = 0·021) on the laparoscopic task compared with the rested state. Caffeine restored psychomotor skills to baseline for time taken (37 versus 35 s; P = 0·101), although the number of errors remained significantly greater than in the rested state (63 versus 59; P = 0·046). Sleep-deprived subjects receiving placebo had slower reaction times (377 versus 299 ms; P = 0·008) and a higher score on the Stanford Sleepiness Scale (6 versus 2 points; P = 0·001) than rested surgeons. Negative effects of sleep deprivation on reaction time were reversed when caffeine (307 ms versus 299 ms in rested state; P = 0·214) or caffeine plus taurine (326 versus 299 ms; P = 0·110) was administered. Subjective sleepiness was also improved, but not to baseline levels.
Sleep deprivation affects laparoscopic psychomotor skills, reaction time and subjective measures of sleepiness in novice surgical subjects. Caffeine and taurine restore simulated laparoscopic performance to rested levels, but do not reduce errors.
British Journal of Surgery 07/2011; 98(11):1666-72. · 4.61 Impact Factor
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ABSTRACT: This paper introduces an articulated robotic device based on universal joints with embedded micro motors for minimally invasive surgery. The device features an articulated distal tip with seven independently controllable degrees-of-freedom (DoF), arranged as two universal joints (intersecting pitch and yaw) and three single DoF joints (yaw only); two Ø3mm internal channels, one for an on-board camera for visualization and the other for passing interventional instruments. The design allows the robot to explore the entire peritoneal cavity from a chosen single incision point. A trans-vaginal procedure using the device to locate the uterine horn, as a model of a human fallopian tube, and apply an endoscopic clip was carried out during a live porcine trial to demonstrate the potential for performing a Natural Orifice Translumenal Endoscopic Surgery (NOTES) tubal ligation procedure.
Robotics and Automation (ICRA), 2011 IEEE International Conference on; 06/2011
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ABSTRACT: Patient-specific simulated rehearsal (PsR) is a technological advance within the domain of endovascular virtual reality (VR) simulation. It allows incorporation of patient-specific computed tomography Digital Imaging and Communications in Medicine (CT DICOM) data into the simulation and subsequent rehearsal of real patient cases. This study aimed to evaluate whether a part-task rehearsal (PTr) of a carotid artery stenting procedure (CAS) on a VR simulator is as effective as a full-task (FTr) preoperative run through.
Medical trainees were trained in the CAS procedure and randomised to a PTr or FTr of a challenging CAS case (Type-II arch). PTr consisted of 30 min of repeated catheterisations of the common carotid artery (CCA). Thereafter, both groups performed the CAS procedure in a fully functional simulated operating suite (SOS) with an interventional team. Technical performances were assessed using simulator-based metrics and expert ratings. Other aspects of performance were assessed using the Non-Technical Skills for Surgeons (NOTSS) scoring.
Twenty trainees were evenly randomised to either PTr or FTr. No differences in performance were seen except for the total time the embolic protection device (EPD) was deployed (9.4 min for the PT vs. 8.1 min for the FT, p = 0.02). Total time (26.3 vs. 25.5 min, p = 0.94), fluoroscopy time (15.8 vs. 14.4 min, p = 0.68), number of roadmaps (10.5 vs. 11.0, p = 0.54), amount of contrast (53.5 vs. 58.0 ml, p = 0.33), time to deploy the EPD (0.9 vs. 0.8 min, p = 0.31) and time to catheterise the CCA (9.2 vs. 8.9 min, p = 0.94) were similar. Qualitative performances as measured by expert ratings (score 24 vs. 24, p = 0.49) and NOTSS (p > 0.05 for all categories) were also comparable.
Part- and full-task rehearsals are equally effective with respect to the operative performance of a simulated CAS intervention. This finding makes a patient-specific rehearsal more efficient and may increase the feasibility of implementation of this technology into medical practice.
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 05/2011; 42(2):158-66. · 2.92 Impact Factor
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ABSTRACT: There have been dramatic changes in surgical training over the past two decades which have resulted in a number of concerns for the development of future surgeons. Changes in the structure of cancer services, working hour restrictions and a commitment to patient safety has led to a reduction in training opportunities that are available to the surgeon in training. Simulation and in particular virtual reality (VR) simulation has been heralded as an effective adjunct to surgical training. Advances in VR simulation has allowed trainees to practice realistic full length procedures in a safe and controlled environment, where mistakes are permitted and can be used as learning points. There is considerable evidence to demonstrate that the VR simulation can be used to enhance technical skills and improve operating room performance. Future work should focus on the cost effectiveness and predictive validity of VR simulation, which in turn would increase the uptake of simulation and enhance surgical training.
Surgical Oncology 05/2011; 20(3):134-9. · 2.44 Impact Factor
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ABSTRACT: It is well established that disorientation during laparoscopic operations such as cholecystectomy is associated with increased morbidity and mortality. The aim of the present study was to evaluate whether high-performance orientation strategies could be taught to a cohort without relevant experience of laparoscopic cholecystectomy, resulting in improved performance and spatial awareness, thereby reducing the need for operative experience to command this skill.
Thirty medical students participated in a randomized controlled trial, with half randomized to a tutorial teaching orientation strategies at specific stages of laparoscopic cholecystectomy and half to a control group without any teaching. Attention as represented by gaze was captured using eye tracking as subjects were presented with 12 images of various stages of the operation, with the task of interpreting the orientation of the image. The primary outcome measure was subject performance in orientation. Secondary outcome measures were gaze dwell time on relevant anatomical structures within the images and comparison of individual behaviour using a visual behaviour profiling algorithm.
The intervention group was significantly more likely to orientate correctly than the control group (mean 75·6 versus 56·1 per cent; P = 0·019). A difference in visual attention behaviour between the two groups was apparent for the majority of images when examining the output of the visual profiling algorithm, in the form of increased homogeneity of visual behaviour and/or an overall difference in orientation strategy. The mean orientation rate of all surgeons under identical conditions in a previously published study was 78·6 per cent.
Training novices in orientation strategies improved their performance significantly and it could reach the level of a surgeon with several years of experience in laparoscopic surgery.
British Journal of Surgery 05/2011; 98(10):1437-45. · 4.61 Impact Factor
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ABSTRACT: This observational study aimed to determine national provision and outcome following pouch surgery (restorative proctocolectomy, RPC) and to examine the effect of institutional and surgeon caseload on outcome.
All patients undergoing primary RPC between April 1996 and March 2008 in England were identified from the administrative database Hospital Episode Statistics. Institutions and surgeons were categorized according to the total RPC caseload performed over the study interval.
Some 5771 primary elective pouch procedures were undertaken at 154 National Health Service hospital trusts. Median follow-up was 65 (interquartile range (i.q.r.) 28-106) months. The 30-day in-hospital mortality rate was 0·5 per cent and the 1-year overall mortality rate 1·5 per cent. Some 30·5 per cent of trusts performed fewer than two procedures per year, and 91·4 per cent of surgical teams (456 of 499) carried out 20 or fewer RPCs over 8 years. Median surgeon volume was 4 (i.q.r. 1-9) cases. Failure occurred in 6·4 per cent of cases. Low-volume surgeons operated on more patients at the extremes of age (P < 0·001) and a lower proportion with ulcerative colitis (P < 0·001). Older age, increasing co-morbidity, increasing social deprivation, and both lower provider and surgeon caseload were independent predictors of longer length of stay. Older patient age and low institutional volume status were independent predictors of failure.
Many English institutions and surgeons carry out extremely low volumes of RPC surgery. Case selection differed significantly between high- and low-volume surgeons. Institutional volume and older age were positively associated with increased pouch failure.
British Journal of Surgery 03/2011; 98(3):408-17. · 4.61 Impact Factor
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ABSTRACT: Traumatic thoracic aortic injuries are serious and may be associated with high morbidity and mortality. Endovascular stent grafting is now an established treatment option which often requires proximal landing zone extension through left subclavian artery (LSA) origin coverage. This in turn can lead to downstream ischaemic complications which may be lessened by LSA revascularisation. This study investigates the consequence of LSA coverage and potential benefit of revascularisation.
Systematic literature review of studies between 1997 and 2010 identified 94 studies incorporating 1704 patients. Chronological trends in LSA management practice for trauma were sought. Designated outcomes of interest were prevalences of left arm ischaemia, stroke, spinal cord ischaemia, endoleak, stent migration, need for additional procedure and mortality. These outcomes were compared in patients with and without LSA coverage (taking account of the degree of coverage). The impact of revascularisation on these outcomes was also explored. Statistical analysis included examination with Chi-Square or Fisher's tests as appropriate.
Isolated total LSA coverage without revascularisation increases the prevalence of left arm ischaemia [prevalence of 4.06% versus 0.0% (p < 0.001)]; stroke [prevalence of 1.19% versus 0.23% (p = 0.025)]; and need for additional procedure [prevalence of 2.86% versus 0.86% (p = 0.004). In contrast there were no reported cases of stroke, spinal cord ischaemia, endoleak, stent migration or mortality when the LSA origin was only partially covered. When the LSA territory was revascularised, again no cases of left arm ischaemia, stroke, spinal cord ischaemia, endoleak, or mortality were reported.
Current evidence suggests that LSA coverage in patients undergoing endovascular stent grafting of the thoracic aorta for trauma should be avoided where possible to avoid ensuing downstream ischaemic complications. When coverage is anatomically necessary, partial coverage is better than complete in terms of avoiding these complications and revascularisation may be considered, however these decisions must be made in the context of the individual patient scenario.
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 02/2011; 41(6):758-69. · 2.92 Impact Factor
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ABSTRACT: BACKGROUND: As an emerging surgical paradigm, NOTES is currently performed using conventional flexible endoscopes. Gastroenterologists are experts in handling this instrument; however, NOTES involves manipulation of the endoscope outside the lumen of the gastrointestinal tract. Surgeons are used to operating within the spatial environment of the peritoneal cavity. The aim of this study was to investigate whether either surgeons or gastroenterologists are superior at navigating the endoscope in a NOTES environment using the Imperial College Natural Orifice Simulated surgical Environment (NOSsE) as an assessment tool. METHODS: Nine novices, 5 gastroenterologists and 4 laparoscopic surgeons were recruited to navigate through a series of targets in the NOSsE phantom. End-points were time taken to complete the course and number of targets successfully visualised. RESULTS: Gastroenterologists and surgeons completed the course faster ( p < 0.001) and revealed more targets than novices ( p < 0.001). Overall, surgeons completed the course in less time than gastroenterologists (mean time 228 sec vs. 134 sec; p = 0.172) and visualised more targets (mean 8.83 vs . 7.53; p = 0.217) although neither reached statistical significance. CONCLUSIONS: The results of this pilot study suggest that surgeons are not disadvantaged when it comes to navigating an endoscope within a simulated NOTES environment compared to gastroenterologists. Therefore, as appears to be the current practice, it is acceptable for surgical teams to perform initial NOTES studies, provided they possess adequate skill, appropriate laboratory experience and ethical review board approval. With the evolution in surgical tools, we are likely to see improved instrumentation to aid in navigation in NOTES.
European Surgery. 01/2011; 43(3):153-157.
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ABSTRACT: The aim of the study was to identify outcome differences amongst patients undergoing resection of colorectal cancer at English National Health Service trusts using Hospital Episode Statistics (HES). A comparison was undertaken of trusts that submitted and those that did not submit, or submitted only poorly, voluntarily to a colorectal clinical registry, the National Bowel Cancer Audit Programme (NBOCAP).
The NBOCAP data set was used to classify trusts according to submitter status. HES data were used for outcome analysis. Data for major resections of colorectal cancer performed between 1 August 2007 and 31 July 2008 were obtained from HES. Trusts not submitting data to NBOCAP and those submitting less than 10 per cent of their total workload were termed 'non-submitters'. HES data for 30-day mortality, length of stay and readmission rates were compared according to submitter and non-submitter status in multifactorial analyses.
A total of 17,722 patients were identified from HES for inclusion. Unadjusted 30-day in-hospital mortality rates were higher in non-submitting than in submitting trusts (5·2 versus 4·0 per cent; P = 0·005). Submitter status was independently associated with reduced 30-day mortality (odds ratio 0·76, 95 per cent confidence interval 0·61 to 0·96; P = 0·021) in regression analysis.
A higher postoperative mortality rate following resection of colorectal cancer was found in trusts that do not voluntarily report data to NBOCAP. Implications regarding the voluntary nature of submission to such registries should be reviewed if they are to be used for outcome benchmarking.
British Journal of Surgery 01/2011; 98(1):132-9. · 4.61 Impact Factor
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ABSTRACT: The development and use of virtual patients has become more expansive. Previous strategies to aid their development have been described to aid their formation. This study describes the development of a series of virtual patients following a methodology proposed by Posel et al [1]. Ten virtual patients with surgical pathology were developed using a reproducible framework. This article serves to guide virtual patient authors as a working description of virtual patient design in order to assist them for future virtual patient development.
Studies in health technology and informatics 01/2011; 163:440-6.
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ABSTRACT: This research addresses the need for the flexible creation of immersive clinical training simulations for multiple interacting participants and virtual patients by using scalable open source virtual world technologies. Initial development of single-user surgical virtual patients has been followed by that of multi-user multiple casualties in a field environment and an acute hospital emergency department. The authors aim to validate and extend their reproducible framework for eventual application of virtual worlds to whole hospital major incident response simulation and to multi-agency, pan-geographic mass casualty exercises.
Studies in health technology and informatics 01/2011; 163:650-2.
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ABSTRACT: Metabolic surgery was developed through the application and experience gained from bariatric or weight loss procedures. Much of our knowledge from the procedures comes from the study of animal models, where they have revealed anatomic feasibility, systemic physiological elements and cellular metabolic effects. The first generation of operation included the jejunoileal bypass and partial ileal bypass that led to the development of the current procedures including Roux-en-Y gastric bypass, biliopancreatic diversion, adjustable gastric banding and sleeve gastrectomy. These operations carry significant metabolic benefits and can reduce the risk of diabetes, heart disease and cancer. Further insights from these animal models can reveal genetic, molecular and systemic effects that can enhance and develop the next generation of metabolic operations.
Obesity Reviews 12/2010; 11(12):907-20. · 7.04 Impact Factor
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ABSTRACT: The introduction of surgical robotics to the field of surgical oncology brings with it an expectation not only of improved vision, instrumentation, and precision but also as a result, a potential for improved oncological outcomes. The current interest in the field of oesophagogastric oncology is explored in this review together with the benefits, real and potential, that robotic assistance offers surgical cancer resection as well as some of the limiting factors which may be hampering its uptake into current surgical practice. A systematic review of all the published literature up until April 2010 was examined across the field of esophageal and gastric cancer resection. A quantitative assessment of the oncological, operative, and functional outcomes was determined from each procedure. The level of evidence behind the results was determined using the Oxford Centre for Evidence-based Medicine Levels of Evidence; Therapy and Prevention. Three hundred and five cases from 19 independent studies were included for review. Nine studies explored the outcomes from robotic-assisted esophagectomy and eight, the robotic-assisted gastrectomy. Two articles included small case series of both procedures. The level of evidence was predominantly based on case series or expert opinion (Level 4 or 5) with only three unmatched or poorly matched comparative trials (Level 4) with no randomized trials evident. Improved operative outcomes and hospital stays were demonstrated with a reduction of 2 days when the robotic-assisted gastrectomy technique was employed compared with the open. No improvement in oncological outcomes could be identified with the use of the robot for either oesophageal or gastric cancer resection; however, in terms of short-term oncological outcomes, these were at least equivalent to the open approach for oesophageal cancer and early stage gastric cancer. Robotic-assisted laparoscopic surgery is a feasible technique to use to perform a safe and oncologically sound resection for oesophageal and early gastric cancer. Operative benefits appear to be encouragingly similar to the laparoscopic approach with some demonstration of improvement over the open technique despite a prolonged operative time. However, the level of evidence is suboptimal and more randomized controlled trials and long-term survival studies within a framework of measured and comparable outcomes is required.
Diseases of the Esophagus 11/2010; 24(4):240-50. · 1.81 Impact Factor
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ABSTRACT: To determine the accuracy of computed tomography (CT) in detecting disease with invasion beyond the muscularis propria (MP) and malignant lymph nodes.
A literature search of Ovid, Embase, the Cochrane database, and Medline using Pubmed, Google Scholar and Vivisimo search engines was performed to identify studies reporting on the accuracy of CT to predict the staging of colonic tumours. Publication bias was demonstrated by Funnel plots. The sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated using a bivariate random effects model and hierarchical summary operating curves (HSROC) were generated.
Nineteen studies fulfilled all the necessary inclusion criteria. The pooled sensitivity, specificity, DOR for detection of tumour invasion were 86% (95% CI: 78-92%); 78% (95% CI: 71-84%); 22.4 (95% CI: 11.9-42.4). Similarly, the values for nodal detection were 70% (95% CI: 63-73%); 78% (95% CI: 73-82%); 8.1(95% CI: 4.7-14.1). In the subgroup analysis, the best results were obtained in studies utilizing multidetector CT (MDCT).
Preoperative staging CT accurately distinguishes between tumours confined to the bowel wall and those invading beyond the MP; however, it is significantly poorer at identifying nodal status. MDCT provides the best results.
Clinical radiology 09/2010; 65(9):708-19. · 1.65 Impact Factor
