Chest CT scan for New Diagnosed colorectal cancer

Presentation on theme: "Chest CT scan for New Diagnosed colorectal cancer"— Presentation transcript:

1 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

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

3 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

4 NCCN guidelines for colorectal cancer Ver 2.2017

5 NCCN guidelines for colorectal cancer Ver 2.2017

6 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

7 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

8 CXR (case1) typical lung metastases
0330/2008

9 CT scan (case2) typical lung metastases
0330/2008

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

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

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

13 CT scan (case4) lung cancer
0330/2008

14 CT scan (case5) suspecious lesions
0330/2008

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

16 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

17 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

18 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

19 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

20 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

21 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

22 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

23 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?)

24 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