Inoperability decision in GIS malignancies: How sufficient is CT alone?

Abstract

The prognosis in gastrointestinal system malignancies is directly correlated with the stage of the disease at the time of presentation. There are debates and variations in the preferred methods for staging (3,4). Despite being part of the recommendations of international associations in preoperative staging, the adequacy of CT is controversial. In our study, we aimed to investigate the effectiveness of CT in the decision of inoperability based on our case series of patients who were admitted to our clinic with a preliminary diagnosis of gastrointestinal system malignancy and deemed inoperable. At the General Surgery Clinic of - University Training and Research Hospital, demographic data of patients with intraoperatively detected inoperable gastrointestinal malignancies between 2018 and 2023, preoperative CT and endoscopy findings, surgical reports, and neoadjuvant treatment applications were retrospectively analyzed. Preoperative endoscopic and cross-sectional imaging findings were compared with intraoperative findings. The study included 91 patients. The sensitivity of preoperative endoscopy was found to be 80.2%, while the sensitivity of preoperative CT was 69.2%. When comparing organ-based intraoperative findings with the distant invasion signs findings detected in preoperative investigations, no significant difference was found. When the correlation of intraoperative inoperable and widely accepted findings with preoperative treatment was examined, no statistically significant relationship was found in the statistical analysis. In our study, the sensitivity and specificity of CT were found within ranges consistent with the literature. However, the adequacy of CT in invasive and metastatic disease was again found to be low, in line with the literature. Therefore, to prevent misinterpretation, we believe that adding advanced imaging modalities (MRI, PET, EUS) during the preoperative period in addition to CT may help reduce unnecessary laparotomies.

Keywords

• Computed Tomography
• Gastrointestinal Malignancies
• Surgical Oncology

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