Correlation between preoperative CT scan and lung metastases according to surgical approach in patients with colorectal cancer

Introduction: The number of lung metastases (M1) of colorectal carcinoma (CRC) in relation to the findings of computed tomography (CT) is the object of study. Methods: Prospective and multicenter study of the Spanish Group for Surgery of CRC lung metastases (GECMP-CCR). The role of CT in the detection of pulmonary M1 is evaluated in 522 patients who underwent a pulmonary metastasectomy for CRC. We define M1/CT as the ratio between metastatic nodules and those found on preoperative CT. Disease-specific survival (DSS), disease-free survival (DFS), and surgical approach were analyzed using the Kaplan-Meier method. Results: 93 patients were performed by video-assisted surgery (VATS) and 429 by thoracotomy. In 90%, the M1/CT ratio was <= 1, with no differences between VATS and thoracotomy (94.1% vs 89.7%, p = 0.874). In the remaining 10% there were more M1s than those predicted by CT (M1/CT > 1), with no differences between approaches (8.6% vs 10%, p = 0.874). 51 patients with M1/CT > 1, showed a lower median DSS (35.4 months vs 55.8; p = 0.002) and DFS (14.2 months vs 29.3; p = 0.025) compared to 470 with M1/CT <= 1. No differences were observed in DSS and DFS according to VATS or thoracotomy. Conclusions: Our study shows equivalent oncological results in the resection of M1 of CRC using VATS or thoracotomy approach. The group of patients with an M1/CT ratio >1 have a worse DSS and DFS, which may mean a more advanced disease than predicted preoperatively. (C) 2020 AEC. Published by Elsevier Espana, S.L.U. All rights reserved.

Automated summary

This study evaluated the effectiveness of CT in detecting pulmonary metastases in colorectal cancer patients and compared the differences between video-assisted surgery and thoracotomy. The results showed that the majority of patients had an M1/CT ratio of ≤1, with no difference between surgical approaches. A minority of patients had more M1 nodules than predicted by CT, and these patients had lower disease-specific survival and disease-free survival. There was no difference in DSS and DFS between VATS and thoracotomy.