INTRODUCTION: Incidental pulmonary nodules are frequently identified during staging investigations for esophageal cancer patients. Their clinical significance is unclear and may bias treatment decisions towards palliative options. METHODS: From 2005 to 2011, 423 esophageal cancer patients were treated at a tertiary hospital. Those with incidental pulmonary nodules were identified. Demographics, imaging, pathology and perioperative outcomes were analyzed. RESULTS: Ninety-two patients (22 %) had lung nodules. Twenty-nine (32 %) were palliative due to poor performance status or extra-pulmonary distant metastasis on imaging. Sixty-three had no evidence of extra-pulmonary metastasis and underwent curative-intent treatment comprising of neoadjuvant therapy [35 (55 %)] followed by esophagectomy [with lung resection, 33 (52 %) or without lung resection, 30 (48 %)]. Of those 33 lung resections, there were 27 benign lesions, 4 stage I lung cancers, and 1 esophageal cancer metastasis. Of 30 patients with lung nodules that underwent curative esophagectomy without lung resection, none showed interval size increase on follow-up imaging [median 9 months (3-40)]. There was no difference in perioperative complications or mortality between patients with combined esophagectomy and lung resection and those with esophagectomy alone. CONCLUSION: Incidental pulmonary nodules in the absence of extra-pulmonary metastases in esophageal cancer patients are rarely metastases and should not bias caregivers towards palliative therapy.
INTRODUCTION: Incidental pulmonary nodules are frequently identified during staging investigations for esophageal cancerpatients. Their clinical significance is unclear and may bias treatment decisions towards palliative options. METHODS: From 2005 to 2011, 423 esophageal cancerpatients were treated at a tertiary hospital. Those with incidental pulmonary nodules were identified. Demographics, imaging, pathology and perioperative outcomes were analyzed. RESULTS: Ninety-two patients (22 %) had lung nodules. Twenty-nine (32 %) were palliative due to poor performance status or extra-pulmonary distant metastasis on imaging. Sixty-three had no evidence of extra-pulmonary metastasis and underwent curative-intent treatment comprising of neoadjuvant therapy [35 (55 %)] followed by esophagectomy [with lung resection, 33 (52 %) or without lung resection, 30 (48 %)]. Of those 33 lung resections, there were 27 benign lesions, 4 stage I lung cancers, and 1 esophageal cancer metastasis. Of 30 patients with lung nodules that underwent curative esophagectomy without lung resection, none showed interval size increase on follow-up imaging [median 9 months (3-40)]. There was no difference in perioperative complications or mortality between patients with combined esophagectomy and lung resection and those with esophagectomy alone. CONCLUSION: Incidental pulmonary nodules in the absence of extra-pulmonary metastases in esophageal cancerpatients are rarely metastases and should not bias caregivers towards palliative therapy.
Authors: Henderik L van Westreenen; Pierre A M Heeren; Hendrik M van Dullemen; Eric J van der Jagt; Pieter L Jager; Henk Groen; John Th M Plukker Journal: J Gastrointest Surg Date: 2005-01 Impact factor: 3.452
Authors: Stephen J Swensen; James R Jett; Thomas E Hartman; David E Midthun; Jeff A Sloan; Anne-Marie Sykes; Gregory L Aughenbaugh; Medy A Clemens Journal: Radiology Date: 2003-01-24 Impact factor: 11.105