Determination of the timing for thoracic imaging prior to pulmonary metastasectomy: an analysis on surgical planning and lesion detection

Abstract

Aims: The aim of this study is to reveal the relationship between the timing of thoracic computed tomography (CT) imaging conducted prior to surgery and the pre-surgical period in patients planned for pulmonary metastasectomy (PM), and to determine a safe pre-surgical timing for thoracic CT. Methods: This study is a retrospective cohort study examining the data of patients who underwent pulmonary metastasectomy (PM). The research includes 96 patients who underwent PM between January 2017 and July 2022. Patients’ demographic data, primary malignancy diagnoses, type of operation, sizes of masses requiring anatomical resection, the number of lesions detected in thoracic CT, the number of lesions identified during surgery, and the timing of thoracic tomography were recorded. The timing of thoracic CT imaging was compared with the number of lesions detected preoperatively and postoperatively. Results: The study included 96 patients, comprising 49 females and 47 males. The most common primary pathological diagnosis was colon cancer at 36.5%, followed by breast cancer at 12.5%. 66.6% of the patients were operated on with thoracotomy, 29.1% with video-assisted thoracoscopic surgery (VATS), and 4.2% with rethoracotomy. The average number of lesions detected in preoperative thoracic tomography was 1.67±0.96, while the average number of lesions detected during surgery was 2.03±1.41. In patient groups where thoracic CT was performed 10 days or less before the operation, no significant difference was found between the number of lesions detected during surgery and the number of lesions in the CT. However, in patients where thoracic CT was performed more than 10 days before the operation, the number of lesions detected during surgery was significantly higher than the number of lesions detected in the CT. Conclusion: In this research, it was concluded that for patients planned for PM, repeating thoracic CT after the 10th day following the initial detection of metastases in the pre-surgical phase may contribute to the detection of more lesions.