[Study on the timing of diagnosis and resection of lung nodules found during the postoperative observation of patients with cancer of the digestive tract].

We investigated 9 patients that had undergone resection of a pulmonary nodule discovered during postoperative observation after surgery for cancer of the digestive tract, in the past 9 years. Six of the primary lesions were colorectal carcinoma, and the others were 1 case each of esophageal carcinoma, hepatocellular carcinoma, and carcinoma of the papilla of Vater. Age at the time of first lung resection was 55 to 77 years (median 63), and the male to female ratio was 6:3. In 4 patients, pulmonary nodules were found within 1 year of primary lesion resection, and in 3 of these patients pulmonary resection was performed after it was confirmed that the nodule had increased in size. In 1 of the 4, biopsy was performed immediately after identification of a pulmonary nodule. The other 5 patients in this study were diagnosed with lung metastases between 2 and 7 years after resection of the primary lesions. Amongst this group, 7 patients had 1 nodule, whilst they were single cases of 2 and 3 nodules. In a patient with esophageal carcinoma, a right re-thoracotomy was performed. In all other patients, video-assisted thoracic surgery was performed. One patient who had had re-resection of a lung metastasis was subsequently found to have further lung metastasis. Survival after resection of the primary lesion was from 30 months to > 110 months (median survival: >82 months), whilst survival after pulmonary resection was from 6 months to >80 months (median survival: 26 months), and 5 patients are still alive. Histological examination of the resected lung lesion showed metastatic lung tumor in 7 cases, and primary lung cancer in 2 cases. It is better to perform the diagnostic biopsy before pulmonary resection in order to determine the best operative procedure, although it is difficult to perform biopsy on a small lung nodule. It is particularly important that any small pulmonary lesion found in the early postoperative period should be resected after confirming that it has increased in size.