Clinical significance of subcentimeter pulmonary nodules in patients undergoing hepatectomy for colorectal liver metastases

Background and Objectives The clinical significance of lung metastases regarded as subcentimeter pulmonary nodules (SPN) before hepatectomy for colorectal liver metastases (CLM) has not been assessed well. Methods The data from 569 patients undergoing hepatectomy for CLM from 2010 to 2016 were reviewed. The presence and final diagnosis of SPN were analyzed for their association with overall survival (OS). Results A total of 143 patients had SPN (25.1%). SPN were proved to be lung metastases in 43 patients (30.1%). Before hepatectomy, lung metastases were suspected in 25 patients (sensitivity: 58%; specificity: 100%). The 5-year OS of patients with lung metastases (45.4%) was worse than that of those with no pulmonary nodules (60.9%,P = .003). There was no significant difference in the 5-year OS between the patients with lung metastases diagnosed after hepatectomy (48.7%) and before hepatectomy (41.2%,P = .432). The 5-year OS of patients who underwent surgery for lung metastases after hepatectomy (60.5%) was similar to that of those with no pulmonary nodules and benign pulmonary nodules (60.9%,P = .6310; 44.0%,P = .899). Conclusion Although diagnostic sensitivity for SPN before hepatectomy is low, timing of diagnosis does not affect OS. Conclusive lung resection offers OS similar to that of patients without lung metastases.