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Journal of Gastrointestinal Surgery

, Volume 16, Issue 12, pp 2256–2259 | Cite as

Indeterminate Pulmonary Nodules Represent Lung Metastases in a Significant Portion of Patients Undergoing Liver Resection for Malignancy

  • Stephanie Downs-Canner
  • Runalia Bahar
  • Srinevas K. Reddy
  • Jon S. Cardinal
  • J. Wallis Marsh
  • David A. Geller
  • Allan TsungEmail author
Original Article

Abstract

Introduction

Despite detection on imaging before resection of hepatic malignancies, the natural history of indeterminate pulmonary nodules (IPN) is unknown. The objective of this study is to determine how often IPN detected on imaging before surgery for hepatic malignancies represent lung metastases.

Methods

Demographics, comorbidities, tumor characteristics, and surgical treatments of patients with pre-operative IPN who underwent liver resection and/or radiofrequency ablation for malignant diagnoses were reviewed.

Results

From 2000 to 2010, 90 patients with at least one IPN underwent liver resection or radiofrequency ablation for malignancy. Of these, 44 (48.9 %), 32 (35.6 %), and 14 (15.6 %) patients had colorectal cancer liver metastases (CRCLM), primary hepatobiliary malignancies (HB), and other cancers, respectively. The median number of IPN was 1. The median size was 4 mm. Twenty (22 %) patients had isolated lung recurrence after hepatic surgical therapy. Eighty percent occurred in the exact location of the pre-operative IPN. Isolated lung recurrence was more common among patients with CRCLM compared to those with HB and other cancers (42.9 vs. 9.4 vs. 14.3 %, p = 0.004).

Conclusion

Pre-operatively detected IPN represent lung metastases in a substantial portion of patients undergoing surgery for hepatic malignancy. IPN are more likely to represent lung metastases in patients with CRCLM compared to those with primary HB and other cancers.

Keywords

Indeterminate pulmonary nodule Hepatic malignancy Metastatic liver disease Extrahepatic recurrence Metastatic colorectal cancer 

References

  1. 1.
    Maithel SK, Ginsberg MS, D'Amico F, DeMatteo RP, Allen PJ, Fong Y, Blumgart LH, Jarnagin WR, D'Angelica MI. Natural history of patients with subcentimeter pulmonary nodules undergoing hepatic resection for metastatic colorectal cancer. J Am Coll Surg. 2010; 210:31–38.PubMedCrossRefGoogle Scholar
  2. 2.
    Choi DJ, Kwak JM, Kim J, Woo SU, Kim SH. Preoperative chest computerized tomography in patients with locally advanced mid or lower rectal cancer: its role in staging and impact on treatment strategy. J Surg Oncol. 2010; 102:588–592.PubMedCrossRefGoogle Scholar
  3. 3.
    Brent A, Talbot R, Coyne J, Nash G. Should indeterminate lung lesions reported on staging CT scans influence the management of patients with colorectal cancer? Colorectal Dis 2007; 9:816–818.PubMedCrossRefGoogle Scholar
  4. 4.
    Quyn A, Matthews A, Daniel T, Amin A, Yalamarthi S. The clinical significance of radiologically detected indeterminate pulmonary nodules in colorectal cancer. Colorectal Dis. 2011. doi: 10.1111/j.1463-1318.2011.02722.x.
  5. 5.
    Sotiropoulos GC, Kuehl H, Sgourakis G, Molmenti EP, Beckebaum S, Cicinnati VR, Baba HA, Schmitz KJ, Broelsch CE, Lang H. Pulmonary nodules at risk in patients undergoing liver transplantation for hepatocellular carcinoma. Transpl Int. 2008; 21: 850–856.PubMedCrossRefGoogle Scholar
  6. 6.
    Concejero A., Yong CC, Chen CL, Lu HI, Wang CC, Wang SH, Liu YW, Yang CH, Cheng YF, Jawan B. Solitary pulmonary nodule in the liver transplant candidate: importance of diagnosis and treatment. Liver Tranpl. 2010; 16:760–766.Google Scholar
  7. 7.
    Wiering B, Krabbe PF, Jager GJ, Oyen WJ, Ruers TJ. The impact of fluor-18-deoxyglucose-positron emission tomography in the management of colorectal liver metastases. Cancer. 2005; 104:2658–70.PubMedCrossRefGoogle Scholar
  8. 8.
    Strasberg SM and Dehdushti F. Role of FDG-PET staging in selecting the optimum patient for hepatic resection of metastatic colorectal cancer. J Surg Oncol. 2010; 102:955–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Yoo IR, Kim SH, Sohn HS, Chung SK. Clinical significance of small pulmonary nodules with little or no 18 F-FDG uptake on PET/CT images of patients with nonthoracic malignancies. J Nucl Med. 2007; 48:15–21.PubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • Stephanie Downs-Canner
    • 1
  • Runalia Bahar
    • 1
  • Srinevas K. Reddy
    • 2
  • Jon S. Cardinal
    • 1
  • J. Wallis Marsh
    • 1
  • David A. Geller
    • 1
  • Allan Tsung
    • 1
    Email author
  1. 1.Division of Hepatobiliary and Pancreatic Surgery, UPMC Liver Cancer Center, Montefiore HospitalUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Department of SurgeryUniversity of Maryland Medical CenterBaltimoreUSA

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