Routine preoperative chest computerized tomography does not influence therapeutic strategy in patients with colorectal cancer


Please, send correspondence to:
Angelo Restivo, MD
Department of General Surgery, Colorectal Unit, University of Cagliari, Italy
Policlinico Universitario Monserrato - 09100 CAGLIARI - ITALY
Telephone: 0039-070-51096052
Fax: 0039-070-51096436


Aim:  Patients with lung metastasis from colorectal cancer may benefit from surgical resection. Chest computerised tomography (CT) is often included in the preoperative staging. Interpretation of the nature of pulmonary lesions is not always easy and may question its clinical value.

Method:  Clinical data of all patients treated at our institution for colorectal cancer (CRC) have been collected prospectively in a dedicated database. Since August 2008 chest CT has been routinely performed for preoperative staging. The outcome of 147 patients operated since then (Group A) was compared with a numerically equal group of patients (147) (Group B) treated before the introduction of preoperative routine Chest CT.

Results: Pulmonary lesions were identified in 45 (30%) patients in Group A and 10 (6.8%) in Group B. Ten and 9 lesions respectively were interpreted as metastases. In 28 (19%) patients in Group A, the lesions were considered to be indeterminate and only four were confirmed as malignant. Overall metastases were present after one year of follow-up in 5 (50%) of 10 patients in Group A and 5 (55%) of 9 in Group B. The global incidence of synchronous and metachronous metastases was 6.8% with no statistical difference between the two groups.

Conclusion:  The study shows that chest CT reveals a higher number of pulmonary lesions only a small proportion of which were malignant. The investigation does not add value to routine staging methods in patients with CRC.