Chest CT scan for New Diagnosed colorectal cancer 林耿立 凌茂盛 曾立銘 亞東紀念醫院 大腸直腸外科

Clinical guideline of colorectal cancer staging (traditionally) Colonoscopy CXR Abdominal echo Abdominal + pelvic CT -> colon CT MRI 0330/2008

Role of chest CT for colorectal cancer Pre-op staging of new diagnosed colorectal cancer Post-op follow-up Differentiation for CEA (lung cancer) 0330/2008

NCCN guidelines for colorectal cancer Ver 2.2017

NCCN guidelines for colorectal cancer Ver 2.2017

執行上的困難 健保CT多重部位也僅給付一次 執行次數過頻繁會遭到核刪 來自放射科的抗拒 輻射線劑量的疑慮 腸胃科醫師罕見配合 Over diagnosis 0330/2008

亞東紀念醫院的做法 根據NCCN guideline 調整院內癌症治療指引 2014年8月癌症團隊會議通過, 將chest CT的使用加入院內大腸直腸癌之治療指引

CXR (case1) typical lung metastases 0330/2008

CT scan (case2) typical lung metastases 0330/2008

CT scan (case3) CXR missed lung metastasis 0330/2008

CT scan (case3) CXR missed lung metastasis 0330/2008

CT scan (case3) CXR missed lung metastasis 0330/2008

CT scan (case4) lung cancer 0330/2008

CT scan (case5) suspecious lesions 0330/2008

CT scan (case6) suspect lung meta. -> benign lesion 0330/2008

Aim of study Chest CT in guideline for 3 years 了解並分析執行狀況 確認其效果以及益處 0330/2008

Case collection including criteria 2014/9 ~ 2016/12 New diagnosed colorectal cancer Including carcinoma in situ Radical or palliative resection Post-op follow-up at least 8 months 0330/2008

Case collection exclusion criteria Mortality after operation Lost follow-up after operation (轉院、拒絕追蹤、醫師說不需追蹤) Limited data or error Death during 8 months after operation (病死、意外死、自然死) 0330/2008

Data base 總數 312 資料不全 2 術後死亡 19 Lost F/U 28 8個月內死亡 7 256 0330/2008

Result (1) 術前有接受chest CT 術後追蹤有接受chest CT 總數 百分比 發現轉移 70 27.3% 8 153 59.8% 15 術後發現肺轉移的時間點：7.3個月(平均), 6.0個月(中位數) 發現肺癌：2人 發現mediastinum LAP：2人 發現疑似病變，仍在追蹤中：6人 0330/2008

Result (2) 共26位病患發現肺部有腫瘤(10.2%) 8位病患接受VATS lung resection 5位病患接受combined surgery，其中3位確診為肺轉移(single)*，1位確診為肺癌，1位是良性病灶 3位病患於追蹤期發現並接受手術，2位確診為肺轉移(single)，1位確診為肺癌 *：one patient noted the other lung meta. after 22 months

Result (3) 2位病患發現mediastinum LAP，其中1位接受VATS LN biopsy，確認良性 26位發現肺部有腫瘤的病患(10.2%)中，Lung cancer有兩位，有1位是hypopharyngeal cancer metastases 同時期發現的liver metastases共有23位病患(9.0%)，其中有10位接受肝切除

Discussion Lung metastases are not less than liver metastases Lung metasectomy may improve the prognosis as liver metasectomy Cost effect is hard to evaluate Limits：case number, interval of follow-up, no analysis of survival (double-blind?)

Conclusion Pre-op chest CT is a good tool for diagnosis of colorectal cancer with lung metastasis Serial chest CT for follow-up of colorectal cancer may help the diagnosis of progression disease Further study is needed for survival benefit 0330/2008