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.

Keywords

• Pulmonary metastasectomy
• thoracic computed tomography
• number of lesions
• metastatic disease

Pulmoner metastazektomi öncesi toraks görüntüleme zamanlamasının belirlenmesi: cerrahi planlama ve lezyon tespiti üzerine bir analiz

Abstract

Amaç: Bu çalışmanın amacı, pulmoner metastazektomi (PM) planlanan hastalarda ameliyat öncesi yapılan toraks bilgisayarlı tomografi (BT) görüntülemesinin zamanlaması ile ameliyat öncesi dönem arasındaki ilişkiyi ortaya koymak ve güvenli bir ameliyat öncesi dönem belirlemektir. Torasik BT için cerrahi zamanlama. Yöntemler: Bu çalışma pulmoner metastazektomi (PM) uygulanan hastaların verilerini inceleyen retrospektif bir kohort çalışmasıdır. Araştırmaya Ocak 2017 ile Temmuz 2022 tarihleri arasında PM uygulanan 96 hasta dahil edilmiştir. Hastaların demografik verileri, primer malignite tanıları, operasyon tipi, anatomik rezeksiyon gerektiren kitlelerin boyutları, toraks BT'de tespit edilen lezyon sayısı, operasyon sırasında tespit edilen lezyon sayısı ameliyat ve toraks tomografisinin zamanlaması kaydedildi. Toraks BT görüntülemenin zamanlaması, ameliyat öncesi ve ameliyat sonrası tespit edilen lezyonların sayısıyla karşılaştırıldı. Bulgular: Çalışmaya 49'u kadın, 47'si erkek olmak üzere 96 hasta dahil edildi. En sık görülen primer patolojik tanı %36,5 ile kolon kanseri olurken, bunu %12,5 ile meme kanseri izledi. Hastaların %66,6'sı torakotomi, %29,1'i VATS (Video Yardımlı Torakoskopik Cerrahi), %4,2'si retorakotomi ile ameliyat edildi. Ameliyat öncesi toraks tomografisinde saptanan ortalama lezyon sayısı 1,67±0,96, ameliyat sırasında saptanan ortalama lezyon sayısı ise 2,03±1,41 idi. Ameliyattan 10 gün ve daha kısa süre önce toraks BT çekilen hasta gruplarında ameliyat sırasında tespit edilen lezyon sayısı ile BT'deki lezyon sayısı arasında anlamlı fark saptanmadı. Ancak ameliyattan 10 gün önce toraks BT çekilen hastalarda ameliyat sırasında tespit edilen lezyon sayısı BT'de tespit edilen lezyon sayısından anlamlı olarak fazlaydı. Sonuç: Bu araştırmada PM planlanan hastalarda ameliyat öncesi metastaz tespitini takip eden 10. günden sonra toraks BT'nin tekrarlanmasının daha fazla lezyon tespitine katkı sağlayabileceği sonucuna varıldı.

Keywords

• Pulmoner metastazektomi
• toraks bilgisayarlı tomografisi
• lezyon sayısı
• metastatik hastalık

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