Natural History of Patients with Subcentimeter Pulmonary Nodules Undergoing Hepatic Resection for Metastatic Colorectal Cancer

被引:55
作者
Maithel, Shishir K. [1 ]
Ginsberg, Michelle S. [2 ]
D'Amico, Francesco [3 ]
DeMatteo, Ronald P. [3 ]
Allen, Peter J. [3 ]
Fong, Yuman [3 ]
Blumgart, Leslie H. [3 ]
Jarnagin, William R. [3 ]
D'Angelica, Michael I. [3 ]
机构
[1] Emory Univ, Div Surg Oncol, Dept Surg, Atlanta, GA 30322 USA
[2] Mem Sloan Kettering Canc Ctr, Dept Radiol, New York, NY 10065 USA
[3] Mem Sloan Kettering Canc Ctr, Dept Surg, Hepatopancreatobiliary Serv, New York, NY 10065 USA
关键词
LUNG-CANCER; CT; HEPATECTOMY; RECURRENCE; OUTCOMES; SURGERY;
D O I
10.1016/j.jamcollsurg.2009.09.032
中图分类号
R61 [外科手术学];
学科分类号
摘要
BACKGROUND: CT imaging frequently detects subcentimeter pulmonary nodules (SPN) in patients undergoing resection of colorectal cancer liver metastases. Their clinical significance is unknown. STUDY DESIGN: Patients were identified who underwent hepatic resection for colorectal cancer liver metastases between October 2004 and March 2006. The presence and imaging features of preoperative SPN were analyzed for their association with progression-free survival (PFS), disease-specific survival (DSS), and SPN progression. RESULTS: One hundred sixty patients underwent liver resection and 68 (43%) had SPN identified pre-operatively. Median number of nodules was 1 (75(th) percentile: <= 2 nodules) and median size of the largest was 3 mm (25(th) to 75(th) percentile: 2 to 5 mm). SPN were unilateral in 77%, calcified in 19%, solid in 92%, and smooth in contour in 95% of patients. At median follow-up of 31 months for survivors, SPN were proven to be metastatic disease in 35% of patients (24 of 68), either by radiographic increase in size or number (n = 12) or histologic confirmation after resection (n = 12). Median PFS for the 160 patients was 16 months and 3-year DSS was 78%. There was a trend toward shorter median PFS in patients with preoperative SPN compared with patients with no SPN (12 versus 20 months; p = 0.242). There was no difference in 3-year DSS (70% versus 83%; p = 0.46). SPN progression after hepatic resection did not substantially affect 3-year DSS. Calcified nodules were less likely to progress compared with noncalcified nodules (8% versus 42%; p = 0.03). CONCLUSION: SPN are common among patients undergoing resection of colorectal cancer liver metastases and approximately one-third of these will prove to be metastatic disease. Presence of limited preoperative SPN might be associated with shorter PFS after hepatectomy, but does not substantially impact 3-year DSS, and should not necessarily preclude resection of hepatic metastases. (J Am Coll Surg 2010;210:31-38. (C) 2010 by the American College of Surgeons)
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页码:31 / 38
页数:8
相关论文
共 18 条
  • [1] Abdalla EK, 2004, ANN SURG, V239, P818, DOI 10.1097/01.sla.0000128305.90650.71
  • [2] Perihepatic lymph node micrometastases impact outcome after partial hepatectomy for colorectal metastases
    Bennett, Joseph J.
    Schmidt, Carl R.
    Klimstra, David S.
    Grobmyer, Stephen R.
    Ishill, Nicole M.
    Angelica, Michael D.
    DeMatteo, Ronald P.
    Fong, Yuman
    Blumgart, Leslie H.
    Jarnagin, William R.
    [J]. ANNALS OF SURGICAL ONCOLOGY, 2008, 15 (04) : 1130 - 1136
  • [3] Should indeterminate lung lesions reported on staging CT scans influence the management of patients with colorectal cancer?
    Brent, A.
    Talbot, R.
    Coyne, J.
    Nash, G.
    [J]. COLORECTAL DISEASE, 2007, 9 (09) : 816 - 818
  • [4] A Proposed Diagnostic Approach to the Patient with the Subcentimeter Pulmonary Nodule: Techniques that Facilitate Video-Assisted Thoracic Surgery Excision
    Daniel, Thomas M.
    [J]. SEMINARS IN THORACIC AND CARDIOVASCULAR SURGERY, 2005, 17 (02) : 115 - 122
  • [5] Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer - Analysis of 1001 consecutive cases
    Fong, Y
    Fortner, J
    Sun, RL
    Brennan, MF
    Blumgart, LH
    [J]. ANNALS OF SURGERY, 1999, 230 (03) : 309 - 318
  • [6] Pulmonary nodules resected at video-assisted thoracoscopic surgery: Etiology in 426 patients
    Ginsberg, MS
    Griff, SK
    Go, BD
    Yoo, HH
    Schwartz, LH
    Panicek, DM
    [J]. RADIOLOGY, 1999, 213 (01) : 277 - 282
  • [7] Evaluation of patients with pulmonary nodules: When is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition)
    Gould, Michael K.
    Fletcher, James
    Iannettoni, Mark D.
    Lynch, William R.
    Midthun, David E.
    Naidich, David P.
    Ost, David E.
    [J]. CHEST, 2007, 132 (03) : 108S - 130S
  • [8] Early Lung Cancer Action Project: overall design and findings from baseline screening
    Henschke, CI
    McCauley, DI
    Yankelevitz, DF
    Naidich, DP
    McGuinness, G
    Miettinen, OS
    Libby, DM
    Pasmantier, MW
    Koizumi, J
    Altorki, NK
    Smith, JP
    [J]. LANCET, 1999, 354 (9173) : 99 - 105
  • [9] Improvement in Perioperative outcome after hepatic resection - Analysis of 1,803 consecutive cases over the past decade
    Jamagin, WR
    Gonen, M
    Fong, YM
    DeMatteo, RP
    Ben-Porat, L
    Little, S
    Corvera, C
    Weber, S
    Blumgart, LH
    [J]. ANNALS OF SURGERY, 2002, 236 (04) : 397 - 407
  • [10] Is There a Role for PET in the Evaluation of Subcentimeter Pulmonary Nodules?
    Kernstine, Kemp H.
    Grannis, Frederic W., Jr.
    Rotter, Arnold J.
    [J]. SEMINARS IN THORACIC AND CARDIOVASCULAR SURGERY, 2005, 17 (02) : 110 - 114