title: Routine preoperative chest computed tomography does not influence therapeutic strategy in patients with colorectal cancer.
abstract: OBJECTIVE
  Patients with lung metastasis from colorectal cancer (CRC) may benefit from surgical resection. Chest computed tomography (CT) is often included in the preoperative staging. Interpretation of the nature of pulmonary lesions is not always easy and many question its clinical value.
  
  
  METHODS
  Clinical data for all patients treated at our institution for CRC have been collected prospectively in a dedicated database. Since August 2008 chest CT has been routinely performed for preoperative staging. The outcome of 147 patients operated on since then (Group A) was compared with a numerically equal group of patients (147) (Group B) treated before the introduction of preoperative routine chest CT.
  
  
  RESULTS
  Pulmonary lesions were identified in 45 (30%) patients in Group A and 10 (6.8%) in Group B. Ten and nine lesions, respectively, were interpreted as metastases. In 28 (19%) patients in Group A, the lesions were considered to be indeterminate and only four were confirmed as malignant. Overall metastases were present after 1 year of follow-up in 5 (50%) of 10 patients in Group A and 5 (55%) of 9 in Group B. The global incidence of synchronous and metachronous metastases was 6.8%, with no statistical difference between the two groups.
  
  
  CONCLUSIONS
  This study shows that chest CT reveals a higher number of pulmonary lesions, only a small proportion of which were malignant. The investigation does not add value to routine staging methods in patients with CRC.
authors.affiliation: Department of General Surgery, Colorectal Unit, University of Cagliari, 09100 Cagliari, Italy. angelorestivo@tiscali.it
authors.forename: A
authors.initials: A
authors.lastname: Restivo
authors.forename: L
authors.initials: L
authors.lastname: Zorcolo
authors.forename: S
authors.initials: S
authors.lastname: Piga
authors.forename: I M F
authors.initials: IM
authors.lastname: Cocco
authors.forename: G
authors.initials: G
authors.lastname: Casula
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011300:Preoperative Care; D013997:Time Factors; D014057:Tomography, X-Ray Computed