title: Preoperative chest computerized tomography in patients with locally advanced mid or lower rectal cancer: its role in staging and impact on treatment strategy.
abstract: OBJECTIVE
  Pulmonary metastasis is frequent in rectal cancer. Some guidelines recommend chest computerized tomography (CT) for preoperative workup in rectal cancer patients, which have no solid evidence to support this recommendation. This study was designed to evaluate the role of chest CT on preoperative staging in rectal cancer patients and to assess the impact on treatment strategy.
  
  
  METHODS
  Data were prospectively collected from 103 clinically T3/T4 mid or lower rectal cancer patients who had chest X-ray (CXR) and CT to evaluate lung metastasis. The chest images were classified into four groups: metastasis, indeterminate, benign, and negative. Patients showing indeterminate lesions had follow-up CTs at 3- to 6-month intervals.
  
  
  RESULTS
  Nine patients (8.7%) had pulmonary metastases detected on CT. CXR did not reveal any pulmonary metastatic lesions in four of the nine patients. Of these four, treatment was changed in three patients because of these findings. Forty (38.8%) patients had indeterminate nodules on chest CT. Of these, 37 patients had follow-up CTs and four patients (10.8%) showed interval changes that were confirmed as pulmonary metastasis.
  
  
  CONCLUSIONS
  It seems reasonable to perform chest CT for preoperative staging in patients with T3/T4 mid or lower rectal cancer.
authors.affiliation: Department of Surgery, Sun General Hospital, Daejeon, Korea.
authors.forename: Dong Jin
authors.initials: DJ
authors.lastname: Choi
authors.forename: Jung Myun
authors.initials: JM
authors.lastname: Kwak
authors.forename: Jin
authors.initials: J
authors.lastname: Kim
authors.forename: Si Uk
authors.initials: SU
authors.lastname: Woo
authors.forename: Seon Hahn
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011300:Preoperative Care; D013902:Radiography, Thoracic; D012004:Rectal Neoplasms / Q000473:pathology*; D014057:Tomography, X-Ray Computed