Clinical Differentiations in Stump Granuloma and Stump Recurrence After Lung Resection for Malignancy Using a Stapler

Abstract

Objective. To identify the clinical differences between stump granuloma and stump recurrence after lung resection for malignancy using a stapler. Methods. We conducted retrospective analyses of 4 patients with stump granulomas and 10 patients with stump recurrences who were pathologically diagnosed at our institution from September 2002 to December 2016. Result. The mean intervals from the previous lung resection to the radiological diagnosis of the lesions (disease-free interval: DFI) were 28.0±13.5 months for granulomas and 19.1±13.4 months for stump recurrences. The maximum standardized uptake values (SUV) by ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG PET) were 4.8±2.9 for granulomas and 7.5±3.6 for stump recurrences. The preoperative carcinoembryonic antigen (CEA) levels were 2.5±0.7 ng/dl for granulomas and 12.2±25.3 ng/dl for stump recurrences. However, there were no significant differences in the clinical characteristics between granulomas and recurrences. CEA levels were within normal limits in all granuloma cases, and in all recurrence cases, the SUVmax was >2. The staple lines of the previous resection were present in the peripheral areas of the new masses in all granuloma cases but only seen in about half of the stump recurrence cases. Conclusions. For patients with a short DFI, high SUVmax and CEA levels, and staple lines located in the middle, stump recurrence should be suspected, and a pathological diagnosis should be made, such as via a percutaneous biopsy.