Management of solitary non-calcified pulmonary nodules in patients with colorectal cancer

• Published in: Surgical practice 2008-11, Vol.12 (4), p.108-112
• Main Authors: Lo, Cheuk-Kin, Ng, Vincent W.S., Tai, Dora K.C., Ma, Chan-Chung, Ko, Kai-Ming, Ho, Kwok-Keung
• Format: Article
• Language: English
• Subjects: Clinical outcomes; Colorectal cancer; Colorectal surgery; Disease management; Lung cancer; primary lung cancer; pulmonary secondary; solitary pulmonary nodule
• ISSN: 1744-1625; 1744-1633
• DOI: 10.1111/j.1744-1633.2008.00413.x

Introduction:  In patients with a history of colorectal cancer the management of solitary non‐calcified pulmonary nodules (SNCPN) is difficult because preoperative differentiation between primary lung cancer and that secondary from the colon is not easy. The objective of this study was to determine the prevalence of primary lung cancer and that secondary from the colon in a group of patients and to develop a statistical model for prediction. Methods:  This is a retrospective study of 123 patients with past history of colorectal cancer who underwent pulmonary resection for SNCPN and who have a history of colorectal cancer. Results:  Forty‐four patients (35.8%) were found to have primary lung cancer, and sixty‐nine patients (56.1%) were found to have metastatic adenocarcinoma from a colorectal origin. Ten had benign lesions (8.1%). The presence of pulmonary symptoms and a disease‐free interval > 72 months were the independent predictive factors of primary lung malignancy. When patients had both predictive factors, there was a nearly 90% chance of having primary lung cancer. Conclusion:  Surgical resection is always recommended for patients with SNCPN and a history of colorectal cancer because the chance of malignancy is high. Lobectomy is also suggested if pulmonary symptoms are present and the disease‐free interval is more than 72 months.