New scoring system for the evaluation obstructive degrees based on computed tomography for obstructive colorectal...

Area of Science:

• Radiology
• Oncology
• Surgical Decision Making

Background:

• Obstructive colorectal cancer (OCRC) management relies on the subjective Colorectal Obstruction Scoring System (CROSS).
• CROSS lacks objective parameters, necessitating an objective computed tomography-based obstructive degree (CTOD) scoring system for OCRC.
• Evaluating the CTOD's role in OCRC decision-making and prognosis is crucial.

Purpose of the Study:

• To investigate the correlation between the CTOD and CROSS scoring systems in OCRC.
• To assess the impact of CTOD on short-term and long-term patient prognosis.
• To determine CTOD's utility in guiding preoperative decisions for OCRC.

Main Methods:

• A cohort of 173 OCRC patients was analyzed.
• CTOD was calculated using k-means, proximal-to-distal obstruction ratio, and non-parenchymal area proportion.
• CTOD was integrated with CROSS to evaluate emergency interventions and compare patient outcomes.

Main Results:

• CTOD grade 3 obstruction independently predicted adverse short-term outcomes (OR = 3.390, P = 0.010), whereas CROSS grade did not.
• In the combined CTOD-CROSS system, non-severe obstruction (CTOD 1-2, CROSS 1-4) showed higher emergency intervention complication rates (71.4%) versus non-emergency (41.8%).
• Postoperative pneumonia was more frequent in the emergency intervention group (35.7%) compared to the non-severe obstructive group (8.9%).

Conclusions:

• The CTOD scoring system is valuable for preoperative decision-making in OCRC.
• Utilizing CTOD can help prevent unnecessary emergency interventions and associated complications.
• CTOD demonstrated utility in optimizing OCRC management strategies.