title: Clinical significance of incidental pulmonary nodules in esophageal cancer patients.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of General Surgery, McGill University, Montreal, QC, Canada, amin.madani@mail.mcgill.ca.
authors.forename: Amin
authors.initials: A
authors.lastname: Madani
authors.forename: Jonathan
authors.initials: J
authors.lastname: Spicer
authors.forename: Thierry
authors.initials: T
authors.lastname: Alcindor
authors.forename: Marc
authors.initials: M
authors.lastname: David
authors.forename: Marie
authors.initials: M
authors.lastname: Vanhuyse
authors.forename: Jamil
authors.initials: J
authors.lastname: Asselah
authors.forename: David
authors.initials: D
authors.lastname: Mulder
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ferri
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000628:therapy; D016629:Esophagectomy; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D020360:Neoadjuvant Therapy; D010166:Palliative Care; D011013:Pneumonectomy; D003074:Solitary Pulmonary Nodule / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D055815:Young Adult