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Should Preoperative Chest CT Be Recommended to All Colon Cancer Patients?

Kim, Hye Young MD*; Lee, Soon Jin PhD; Lee, Gilsun MD*; Song, Limwha MD*; Kim, Su-A MD*; Kim, Jin Yong PhD*; Chang, Dong Kyung PhD*; Rhee, Poong-Lyul PhD*; Kim, Jae J. PhD*; Rhee, Jong Chul PhD*; Chun, Ho-Kyung PhD; Kim, Young-Ho PhD*

doi: 10.1097/SLA.0b013e3182865080
Original Articles

Objective: The aim of this study was to evaluate the efficacy of preoperative chest computed tomography (CT) and the risk factors for lung metastasis in colon cancer patients without liver metastasis who had negative findings on initial chest X-ray (CXR).

Background: Preoperative staging with chest CT is recommended in colon cancer patients. However, there have been only scant data on the clinical efficacy.

Methods: Three hundred nineteen consecutive colon cancer patients without liver metastasis were retrospectively reviewed and analyzed. The patients had negative findings on preoperative CXR, and they underwent surgery for colon cancer during the period of January 2008 to April 2010.

Results: Lung nodule on chest CT was found in 136 patients (42.6%). Twenty of those were definitely diagnosed with lung metastasis (6.3%) by follow-up chest CT or pathologic confirmation. There was no case of delay in surgery due to findings of lung nodule. Comparing the group with lung metastases to that without lung metastases, postoperative pathologic findings reported more advanced T and N status (P = 0.004, P < 0.001, respectively), and lymphatic invasion was more frequent (P = 0.003) in the group with lung metastasis. By multivariate analysis, CT-predicted lymph node metastases and pathologic lymph node metastases were risk factors for lung metastases.

Conclusions: Preoperative staging chest CT is not beneficial to colon cancer patients without liver metastasis and lymph node metastasis suggested on abdominal and pelvic CT who had negative finding on initial CXR.

Most guidelines recommend chest imaging for staging of colorectal cancer. Routine preoperative staging chest computed tomography (CT) in colorectal cancer is controversial. Preoperative staging chest CT is not effective in colon cancer patients without nodal disease.

Departments of *Medicine

Radiology; and

Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Reprints: Young-Ho Kim, MD, PhD, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 50, Gangnam-gu, Seoul, 135–710, Korea. E-mail:

H.Y.K. and S.J.L. contributed equally to this work.

Disclosure: The authors declare that they have no conflicts of interest concerning this article.

© 2014 by Lippincott Williams & Wilkins.