Should preoperative chest computed tomography be performed in all patients with colorectal cancer?

Lazzaron, Anderson Rech; Vieira, MV; Damin, Daniel C.

doi:10.1111/codi.13071

Cited by 14 publications

(13 citation statements)

References 24 publications

(52 reference statements)

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“…High‐resolution CT scan of the thorax increases the detection rate of lung metastases in CRC . The National Comprehensive Cancer Network guidelines recommend chest CT for preoperative workup and follow‐up in all patients with CRC .…”

Section: Discussionmentioning

confidence: 99%

“…High-resolution CT scan of the thorax increases the detection rate of lung metastases in CRC. 13,14 The National Comprehensive Cancer Network guidelines recommend chest CT for preoperative workup and follow-up in all patients with CRC. 10 Our study shows a significant increase in referral for Pmet since 2013 compare with pre-CT scan era along with increased detection of synchronous PM, increased diagnosis of EPM, and improved OS2 ( Table 2).…”

Section: Discussionmentioning

confidence: 99%

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Pulmonary metastasectomy of colorectal cancer origin: Evaluating process and outcomes

Kumar

Verma

Shinde

et al. 2018

Journal of Surgical Oncology

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Background This study was undertaken to evaluate the effect of change in policy of computed tomography (CT) scan of the thorax in staging and follow‐up of colorectal cancer (CRC). Another objective was to review the outcomes following pulmonary metastasectomies (Pmets) and to determine the prognostic factors affecting outcomes. Methods This is a retrospective analysis from a prospective cohort database of patients, who underwent Pmet for CRC origin from August 2004 to February 2016. The outcome measures were number of Pmets per year, overall survival (OS), disease‐free survival (DFS), and prognostic factors affecting survival. Results Of 71 patients, 38% (n = 27) underwent Pmet before 2013 and 62% ( n = 44) had surgery after 2013. The 2‐year DFS after Pmet was 49.3% and estimated 5‐year OS was 51.4% at a median follow‐up of 28 months. There was a significant increase in number of Pmets/year ( P = 0.0015), increased detection of synchronous pulmonary metastasis (PM) ( P = 0.005), increased diagnosis of extra‐pulmonary metastases (EPM) ( P = 0.005), and improved OS ( P = 0.026) after introduction of CT scan as staging tool. Site of primary tumor (colon) ( P = 0.045), primary nodal stage ( P = 0.009), and the presence of EPM ( P = 0.01) were independent important prognostic factors affecting survival. Conclusion The CT scan of thorax as a baseline tool for staging and follow‐up in CRC increases referral for pulmonary metastasectomy. Surgery achieves excellent prognosis and long‐term survival outcomes in CRC with isolated PM and carefully selected patients with solitary liver metastasis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pulmonary metastasectomy of colorectal cancer origin: Evaluating process and outcomes

Kumar

Verma

Shinde

et al. 2018

Journal of Surgical Oncology

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“…The number of indeterminate lesions in this study was 17%, while most studies estimate it about 20% -30%. Heterogeneity in studies and the lack of agreement in the definition of ILL confirms this (4). Radiologist experience and improvements in scanning technolo-gies will increase the identifying such lesions (16).…”

Section: Discussionmentioning

confidence: 84%

“…The National Comprehensive Cancer Network has recommended CT rather than plain film radiographic imaging of the chest (12). The main reason for the use of CT for staging is early diagnosis of pulmonary metastases with high sensitivity of 51% to 73% and specificities of up to 74%, which increases the rate of resection of pulmonary metastasis (4,11). CCT is competent for identifying nodules of 2 -3 mm, whereas CXR identifies lesions 5-10 mm in size (13).…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of rectal cancer is estimated to be 35% of total CRC incidence in the European Union (2). The lung is the most common extrahepatic site of distant metastasis from CRC with an incidence of 10% (3,4). Lower rectal tumors have a higher incidence of lung metastasis owing to systemic venous drainage of this portion as opposed to the venous drainage of the colon through the portal system (3,5).…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Efficacy of CXR Compared to Chest CT in Preoperative Staging of Patients with Colorectal Cancer

2019

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Background: The high prevalence of colorectal cancer (CRC) and its increasing incidence can be a major problem in cancer management. Preoperative staging plays a significant role in the therapeutic process, especially in CRC which has high risk for lung metastases. Objectives: This study aimed to evaluate accuracy of chest X-ray (CXR) in comparison with chest CT (CCT) for diagnosing lung metastases in patients with CRC. Patients and Methods: A cross sectional study was conducted of 377 patients with newly diagnosed CRC which were evaluated with CXR and CCT. Results: CCT revealed normal/benign findings in 285 (75.6%), indeterminate nodules in 28 (17%) and suspicious nodules in 64 (17%) patients. Although CXR did not reveal any pulmonary metastatic lesions in of the 23 (7%) patients, the measure of agreement between CXR and CCT was good (0.64, P < 0.01) and CCT changed TNM staging in only eight (2%) patients. On logistic regression analysis, liver metastasis could increase the risk of pulmonary metastasis (P < 0.01). Conclusion: The study suggested CCT for preoperative staging in CRC patients, especially at stages 3 and 4 in TNM staging and for liver metastases.

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Predictive Nomograms for Synchronous Distant Metastasis in Rectal Cancer

Gaitanidis

Alevizakos

Tsaroucha

et al. 2018

Journal of Gastrointestinal Surgery

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Should preoperative chest computed tomography be performed in all patients with colorectal cancer?

Cited by 14 publications

References 24 publications

Pulmonary metastasectomy of colorectal cancer origin: Evaluating process and outcomes

Pulmonary metastasectomy of colorectal cancer origin: Evaluating process and outcomes

Diagnostic Efficacy of CXR Compared to Chest CT in Preoperative Staging of Patients with Colorectal Cancer

Predictive Nomograms for Synchronous Distant Metastasis in Rectal Cancer

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