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

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.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).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.Advanced colorectal carcinoma (CRC), defined as locally advanced or metastasized disease or both, is present in a relevant proportion of patients diagnosed with colorectal cancer. Common localizations for distant metastases are the liver, the peritoneal cavity and the lung. Staging with chest CT as a routine procedure before surgery has not shown to be of clinical benefit, mainly due to the low incidence of clinically relevant lung metastases and low specificity of chest CT [1-3]. Pre-operative staging with abdominal CT might be beneficial when the ability to detect advanced CRC is high enough and the findings offer information that may change the treatment plan. Such findings include liver metastases (LM), peritoneal carcinomatosis (PC) and locally advanced colon cancer (LACC). In the past, these conditions were frequently regarded as incurable and suitable for palliative measures only. Nowadays various multi-modality treatments offer a chance of cure to selected patients [4-15]. For patients with incurable advanced CRC, alternative options are sometimes available and staging may change the t