Determination of the timing for thoracic imaging prior to pulmonary metastasectomy: an analysis on surgical planning and lesion detection

Yıl 2024, , 91 - 96, 30.04.2024

Mesut Buz , Selime Kahraman , Berk Çimenoğlu , Talha Doğruyol , Attila Özdemir , Recep Demirhan

https://doi.org/10.47582/jompac.1428872

Öz

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.

Anahtar Kelimeler

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

Etik Beyan

This study was approved by the local ethics committee (ethics committee ruling number: 2023/514/248/14, date: 27.04.2023).

Destekleyen Kurum

The authors declared that this study has received no financial support.

Proje Numarası

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Teşekkür

None

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

Öz

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.

Anahtar Kelimeler

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

Proje Numarası

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Kaynakça

• 1. Brown JS, Amend SR, Austin RH, Gatenby RA, Hammarlund EU, Pienta KJ. Updating the definition of cancer. Mol Cancer Res. 2023;21(11):1142-1147.
• 2. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of ıncidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249.
• 3. Pastorino U. Lung metastasectomy: why, when, how. Crit Rev Oncol Hematol. 1997;26(3):137-145.
• 4. Motas N, Davidescu MD, Tanase BC, et al. Oncologic outcome after pulmonary metastasectomy as part of multidisciplinary treatment in a tertiary oncological center. Diagnostics. 2023;13(1):165.
• 5. Pfannschmidt J, Egerer G, Bischof M, Thomas M, Dienemann H. Surgical intervention for pulmonary metastases. Dtsch Arztebl Int. 2012;109(40):645-651.
• 6. Mangiameli G, Cioffi U, Alloisio M, Testori A. Lung metastases: current surgical ındications and new perspectives. Front Surg. 2022;9:884915.
• 7. Higashiyama M, Tokunaga T, Nakagiri T, Ishida D, Kuno H, Okami J. Pulmonary metastasectomy: outcomes and issues according to the type of surgical resection. Gen Thorac Cardiovasc Surg. 2015;63(6):320-330.
• 8. Handy JR, Bremner RM, Crocenzi TS, et al. Expert consensus document on pulmonary metastasectomy. Ann Thorac Surg. 2019;107(2):631-649.
• 9. Detterbeck FC, Grodzki T, Gleeson F, Robert JH. Imaging requirements in the practice of pulmonary metastasectomy. J Thorac Oncol. 2010;5(6):S134-S139.
• 10. Tanaka Y, Maniwa Y, Nishio W, Yoshimura M, Okita Y. The optimal timing to resect pulmonary metastasis. Eur J Cardiothorac Surg. 2008;33(6):1135-1138.
• 11. Pfannschmidt J, Hoffmann H, Dienemann H. Reported outcome factors for pulmonary resection in metastatic colorectal cancer. J Thorac Oncol. 2010;5(6):S172-S178.
• 12. Miyake H, Kawai K, Nozawa H, et al. Less intensive surveillance after radical surgery for stage I-III colorectal cancer by focusing on the doubling time of recurrence. Surg Today. 2021;51(4):550-560.
• 13. Ichinose J, Hashimoto K, Matsuura Y, et al. Optimal timing for lung metastasectomy in patients with colorectal cancer. Interact Cardiovasc Thorac Surg. 2022;35(4):ivac224.
• 14. Krüger M, Schmitto JD, Wiegmann B, Rajab TK, Haverich A. Optimal timing of pulmonary metastasectomy – Is a delayed operation beneficial or counterproductive? Eur J Surg Oncol (EJSO). 2014;40(9):1049-1055.
• 15. Kanzaki R, Fukui E, Kanou T, et al. Preoperative evaluation and indications for pulmonary metastasectomy. J Thorac Dis. 2021;13(4):2590.
• 16. Nakamura T, Matsumine A, Matsusaka M, et al. Analysis of pulmonary nodules in patients with high-grade soft tissue sarcomas. PLoS One. 2017;12(2):e0172148.
• 17. Şengül A, Başoğlu A, Bilgin Büyükkarabacak Y, Durgun Yetim T, Kutlu T. Metastatik akciğer tümörlerinin tedavisinde metastazektomi ve prognostik faktörlerin değerlendirilmesi. Türk Göğüs Kalp Damar Cer Derg. 2009;17(2):87-91.
• 18. Guerrera F, Mossetti C, Ceccarelli M, et al. Surgery of colorectal cancer lung metastases: analysis of survival, recurrence and re-surgery. J Thorac Dis. 2016;8(7):1764-1771.
• 19. Lang C, Hrdliczka E, Schweiger T, et al. Impact of cyclooxygenase-2 and prostaglandin-E2 expression on clinical outcome after pulmonary metastasectomy. J Thorac Dis. 2017; 9(3):621-635.
• 20. Klink T, Obmann V, Heverhagen J, Stork A, Adam G, Begemann P. Reducing CT radiation dose with iterative reconstruction algorithms: the influence of scan and reconstruction parameters on image quality and CTDIvol. Eur J Radiol. 2014;83(9):1645-1654.
• 21. Iida T, Nomori H, Shiba M, et al. Prognostic factors after pulmonary metastasectomy for colorectal cancer and rationale for determining surgical indications: a retrospective analysis. Ann Surg. 2013;257(6):1059-1064.
• 22. Cabula C, Campana LG, Grilz G, et al. Electrochemotherapy in the treatment of cutaneous metastases from breast cancer: a multicenter cohort analysis. Ann Surg Oncol. 2015;22(3):442-450.
• 23. Liu B, Xia H. Progress in Surgery for Pulmonary Metastases. Chin J Lung Cancer. 2019;22(9):574-578.
• 24. Schirren M, Bölükbas S, Oguzhan S, Sponholz S, Schirren J. Surgical therapy of lung metastases. Chirurg. 2014;85(9):833-844.
• 25. Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Shimizu H, et al. Thoracic and cardiovascular surgery in Japan in 2016: Annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2019;67(4):377-411.
• 26. Petersen RH, Hansen HJ. Learning thoracoscopic lobectomy. Eur J Cardiothorac Surg. 2010;37(3):516-520.
• 27. Eckardt J, Licht PB. Thoracoscopic versus open pulmonary metastasectomy: a prospective, sequentially controlled study. Chest. 2012;142(6):1598-1602.
• 28. Cerfolio RJ, Bryant AS, McCarty TP, Minnich DJ. A prospective study to determine the incidence of non-imaged malignant pulmonary nodules in patients who undergo metastasectomy by thoracotomy with lung palpation. Ann Thorac Surg. 2011; 91(6):1696-1701.
• 29. Meng D, Fu L, Wang L, et al. Video-assisted thoracoscopic surgery versus open thoracotomy in pulmonary metastasectomy: a meta-analysis of observational studies. Interact Cardiovasc Thorac Surg. 2016;22(2):200-206.
• 30. Nichols FC. Pulmonary metastasectomy: role of pulmonary metastasectomy and type of surgery. Curr Treat Options Oncol. 2014;15(3):465-475.
• 31. Detterbeck FC, Lewis SZ, Diekemper R, Addrizzo-Harris D, Alberts WM. Executive summary: Diagnosis and management of lung cancer: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5):7S-37S.
• 32. Mountain CF, McMurtrey MJ, Hermes KE. Surgery for pulmonary metastasis: a 20-year experience. Ann Thorac Surg. 1984;38(4):323-330.