ARRS 2022 Abstracts

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E1688. Post-Surgical Treatment Changes of Lung Cancer: What to Except and What to Worry About
Authors
  1. Anitha Kini; The Ottawa Hospital
  2. Elena Pena; The Ottawa Hospital
  3. Carole Dennie; The Ottawa Hospital
  4. Carolina Souza; The Ottawa Hospital
Background
Early stage lung cancers are usually treated with surgical resection. Lung resection can be performed using open thoracotomy or minimally invasive surgical techniques including video-assisted thoracoscopic surgery (VATS) or more recently robotic-assisted thoracic surgery (RATS). Surgical procedures for lung cancer include sub-lobar resection (wedge resection or segmentectomy), lobectomy, and pneumonectomy. The purpose of this educational exhibit is to describe expected post-surgical changes in patients treated for lung cancer and review the appearances that should raise suspicion for local recurrence.

Educational Goals / Teaching Points
This exhibit aims to review the spectrum of CT appearances following surgical treatment for lung cancer, including sub lobar resection, lobectomy, and post-pneumonectomy changes and review CT imaging findings related to local recurrence post-surgery.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The CT appearances of lung resection vary according to type and location of surgery, most of them occur within first 2 years after complete resection. Wedge resection involves the removal of a non-anatomical portion of the lung containing the tumor with a margin of adjacent healthy parenchyma. Segmentectomy is an anatomical resection of the lung based on segmental vessels and airways. Lobectomy is the resection of an entire lobe and its surrounding pleura, associated airways, and pulmonary vasculature. Pneumonectomy involves resection of an entire lung. Local recurrence may manifest on CT as new or enlarging soft tissue at the staple line or near the bronchial stump. Enhancing soft tissue at the surgical site within 3 months after resection may represent inflammatory changes. Follow-up imaging is recommended to assess the progression or stability of the enhancing soft tissue.

Conclusion
Each of these surgical approaches are associated with a varying predisposition for postoperative changes. It is important for radiologists to be familiar with the expected postoperative imaging appearance of various surgical procedures used in the treatment of patients with lung cancer and to differentiate from local recurrence.