Thorac cardiovasc Surg 2014; 62(07): 616-623
DOI: 10.1055/s-0033-1363767
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Approach to Metastasis-Suspected Nodule Accompanying Operable Non-Small Cell Lung Cancer

Sumin Shin
1  Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Joon Suk Park
2  Department of Thoracic and Cardiovascular Surgery, Bundang CHA Hospital, CHA University, Seongnam-si, Republic of Korea
,
Hong Kwan Kim
1  Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Yong Soo Choi
1  Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Young Mog Shim
1  Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Ho Yun Lee
3  Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Jhingook Kim
1  Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
› Author Affiliations
Further Information

Publication History

06 July 2013

10 November 2013

Publication Date:
20 April 2014 (online)

Abstract

Background Operability is difficult to determine in patients with additional pulmonary nodules in nonprimary lobes accompanying resectable lung cancer. Because these nodules could either be malignant or benign, the differential diagnosis is fundamental but still remains a diagnostic challenge. The aim of this study was to evaluate metastasis-suspected solid nodules in nonprimary lobes accompanying resectable non-small cell lung cancer (NSCLC).

Patients and Methods From 2003 to 2009, 2,997 patients underwent pulmonary resection for NSCLC. Among them, 62 patients who underwent pulmonary resection for additional nodules in nonprimary lobes to exclude metastasis were identified. Their medical records were analyzed retrospectively.

Results There were 48 males and 14 females, with a mean age of 61 years (range, 35–76 years). Tumors were located in ipsilateral nonprimary lobes in 16 patients, contralateral lobes in 21 patients, and bilateral lobes in 25 patients. Sixty-six resections were performed in the 62 patients including four cases of multiple resections. Forty-six nodules (70%) were pathologically confirmed as benign and 20 nodules (30%) were diagnosed with malignancy. The accuracy of radiologic malignancy diagnosis was 32% (20 out of 62). Two patients died of acute respiratory distress syndrome during the postoperative period. Both of these patients underwent lobectomy following additional resection for satellite nodules, which were located on the contralateral side.

Conclusion If patients have satellite nodules accompanying resectable NSCLC, aggressive pathological assessment should be considered. However, bilateral procedures can increase postoperative morbidity and mortality; therefore, staged operation or close follow-up might be the alternative strategy.