Abstract
Aims
Hepatic metastasectomy remains the only potentially curative treatment for colorectal liver metastases (CRLM). Some of these patients develop indeterminate pulmonary nodules (IPNs). This study aimed to compare outcomes of patients with and without IPN undergoing resection of CRLM to ascertain whether their presence is clinically significant.
Methods
Cases and controls were identified from a prospectively maintained database of CRLM resections. Patients with staging radiology demonstrating IPNs were included as cases. Controls were matched to the cases by four primary factors: age, type of resection (primary or redo), clinical risk score (CRS) and chemotherapy.
Results
The median disease-free survival (DFS) and overall survival (OS) for the cases were 7.0 months (95% CI 4.8–9.2) and 28.6 months (95% CI 21.2–36.0), respectively, and 12.0 months (95% CI 10.7–13.2) and 30.5 months (95% CI 19.4–41.6) for the controls. The 1-, 3- and 5-year survival rates were 92.7, 39.7 and 0.0% for the IPN group, and 92.4, 32.9 and 21.9% for those without. In total, 60.7% of IPN patients progressed to lung metastases, of which 39.3% underwent pulmonary resections. DFS was significantly shorter in the IPN group (p = 0.022), but OS was not significantly different (p = 0.421). The presence of IPN was independently associated with a shortened DFS (p = 0.027), as was a CRS of 3 or greater (p = 0.007).
Conclusion
This study suggests that IPN does not significantly affect OS, but may predict earlier disease recurrence. IPN presence alone should not preclude radical resection but could be used to prompt more careful post-operative surveillance to detect lung metastases at a potentially operable stage.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Office for National Statistics (2013) Bowel cancer incidence and mortality statistics. http://www.ons.gov.uk/ons/search/index.html?newquery=cancer+registrations. Accessed Dec 2014
Cancer Research UK (2016) Bowel cancer incidence statistics. http://www.cancerresearchuk.org/cancer-info/cancerstats/types/bowel/incidence/. Accessed Dec 2016
Elferink MA, de Jong KP, Klaase JM et al (2015) Metachronous metastases from colorectal cancer: a population-based study in North-East Netherlands. Int J Colorectal Dis 30(2):201–212
Jemal A, Bray F, Center MM et al (2011) Global cancer statistics. CA Cancer J Clin 61(2):69–90
Choti MA, Sitzmann JV, Tiburi MF et al (2002) Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 235(6):759–766
Třeška V, Skalický T, Ferda J et al (2014) Colorectal liver metastases surgery—the present and the perspectives. Rozhl Chir 93(12):568–571
Fernandez FG, Drebin JA, Linehan DC et al (2004) Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Ann Surg 240:438–447
Ismaili N (2011) Treatment of colorectal liver metastases. World J Surg Oncol 9:154
Nordholm-Carstensen A, Jorgensen LN, Wille-Jørgensen PA et al (2015) Indeterminate pulmonary nodules in colorectal-cancer: do radiologists agree? Ann Surg Oncol 22(2):543–549
Nordholm-Carstensen A, Wille-Jørgensen PA, Jorgensen LN et al (2013) Indeterminate pulmonary nodules at colorectal cancer staging: a systematic review of predictive parameters for malignancy. Ann Surg Oncol 20(12):4022–4030
Gomez D, Kamali D, Dunn WK et al (2012) Outcomes in patients with indeterminate pulmonary nodules undergoing resection for colorectal liver metastases. HPB (Oxford) 14(7):448–454
Hansell DM, Bankier AA, MacMahon H et al (2008) Fleischner Society: glossary of terms for thoracic imaging. Radiology 246(3):697–722
Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247
Fong Y, Fortner J, Sun RL et al (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer. Ann Surg 230(3):309–321
Patkar V, Acosta D, Davidson T et al (2011) Cancer multidisciplinary team meetings: evidence, challenges and the role of clinical decision support technology. Int J Breast Cancer 2011:17
National Institute for Health and Care Excellence (NICE) (2014) The diagnosis and management of colorectal cancer: NICE clinical guideline 131. https://www.nice.org.uk/guidance/cg131/resources/guidance-colorectal-cancer-pdf. Accessed Dec 2014
Van Cutsem E, Nordlinger B, Adam R et al (2006) European colorectal metastases treatment group: towards a pan-European consensus on the treatment of patients with colorectal liver metastases. Eur J Cancer 42(14):2212–2221
Inoue M, Ohta M, Iuchi K et al (2004) Benefits of surgery for patients with pulmonary metastases from colorectal carcinoma. Ann Thorac Surg 78(1):238–244
Quyn AJ, Matthews A, Daniel T et al (2012) The clinical significance of radiologically detected indeterminate pulmonary nodules in colorectal cancer. Colorectal Dis 14(7):828–831
Varol Y, Varol U, Karaca B et al (2012) The frequency and significance of radiologically detected indeterminate pulmonary nodules in patients with colorectal cancer. Med Princ Pract 21:457–461
Griffiths SN, Shaikh I, Tam E et al (2012) Characterisation of indeterminate pulmonary nodules in colorectal cancer. Int J Surg 10:575–577
Brent A, Talbot R, Coyne J et al (2007) Should indeterminate lung lesions reported on staging CT scans influence the management of patients with colorectal cancer? Colorectal Dis 9:816–818
Baek SJ, Kim SH, Kwak JM et al (2012) Indeterminate pulmonary nodules in rectal cancer: a recommendation for follow-up guidelines. J Surg Oncol 106(4):481–485
Kim CH, Huh JW, Kim HR et al (2015) Indeterminate pulmonary nodules in colorectal cancer: follow-up guidelines based on a risk predictive model. Ann Surg 261(6):1145–1152
Maithel SK, Ginsberg MS, D’Amico F et al (2010) Natural history of patients with sub-centimetre pulmonary nodules undergoing hepatic resection for metastatic colorectal cancer. J Am College Surg 210:31–38
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None declared.
Rights and permissions
About this article
Cite this article
Robertson, V., Neal, C.P., Jones, M. et al. Indeterminate Pulmonary Nodules in Resected Liver Metastases from Colorectal Cancer: A Comparison of Patient Outcomes. World J Surg 41, 1834–1839 (2017). https://doi.org/10.1007/s00268-017-3930-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-017-3930-x