Contrast-enhanced CT colonography in colon cancer: expanding roles in staging, surgical planning and clinical decision-making

CT colonography (CTC) is an established alternative to optical colonoscopy in cases of incomplete examination or obstructive colorectal lesions; however, its role in colon cancer management remains incompletely defined and likely underutilized. This review provides a clinically oriented synthesis of current evidence on the role of contrast-enhanced CTC (CE-CTC) in colon cancer, focusing on diagnosing, staging, preoperative planning, and multidisciplinary decision-making. By combining luminal distension with intravenous contrast enhancement, CE-CTC may improve visualization of both intraluminal and transmural tumor extent compared with conventional CT. This approach may facilitate precise tumor localization and assessment of mural invasion and circumferential tumor involvement, thereby supporting clinical decision-making regarding neoadjuvant treatment. Furthermore, detailed mesenteric vascular mapping may support surgical planning by guiding lymph node dissection and central vascular ligation, with the goal of achieving oncologically adequate (R0) resection. In an evolving therapeutic landscape, CE-CTC may serve as a complementary imaging modality to enhance preoperative assessment and support individualized management strategies. Prospective studies are needed to further define its role and integration into clinical pathways.