doi:10.1510/icvts.2010.260067
Interactive CardioVascular and Thoracic Surgery 13 (2011) 16–20 www.icvts.org
Institutional report - Pulmonary
Acute exacerbation of idiopathic interstitial pneumonias after surgical resection of lung cancer Masato Kanzakia,*, Takuma Kikkawaa, Hideyuki Maedaa, Mitsuko Kondob, Tamami Isakaa, Toshihide Shimizua, Masahide Murasugia, Takamasa Onukia a
Department of Surgery I, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan b First Department of Medicine, Tokyo Women’s Medical University, Tokyo, Japan Received 5 November 2010; received in revised form 15 February 2011; accepted 3 March 2011
Abstract Idiopathic interstitial pneumonias (IIPs) are diffuse lung diseases of unknown cause. Morbidity and mortality are high in patients with IIPs who have undergone lung resection. Postoperative acute exacerbation (PAE) of IIPs is one of the fatal complications after lung resection. From January 2001 to October 2009, 758 consecutive patients with lung cancer who had undergone lung resection at Tokyo Women’s Medical University Hospital were investigated retrospectively. Forty (5.3%) of 758 patients had IIPs. PAE of IIPs was developed in 12 of the patients with IIPs. There were no significant differences in the age, gender, operation methods, histology, and pathological stage in the patients with or without PAE of IIPs. Three patients died of uncontrollable PAE of IIPs in hospital. The 30-day mortality of patients with PAE of IIPs in the last nine-year period has clearly decreased compared with the 30-day mortality of patients with PAE of IIPs between January 1996 and December 2000. PAE of IIPs causes high mortality. It is very difficult to predict the occurrence of PAE of IIPs. More efforts are required to develop strategies to prevent PAE of IIPs. 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved. Keywords: Lung cancer; Idiopathic interstitial pneumonias; Lung resection; Perioperative care; Surgery complication
1. Introduction Idiopathic interstitial pneumonias (IIPs) are diffuse lung disease of unknown cause. Morbidity and mortality are high in patients with IIPs who underwent lung resection. In particular, postoperative acute exacerbation (PAE) of IIPs is one of the fatal complications after lung resection [13]. To further evaluate frequency and perioperative mor tality, we reviewed our surgical results in patients with lung cancer combined IIPs over a nine-year period. 2. Patients and methods From January 2001 to October 2009, 758 consecutive patients with lung cancer who underwent pulmonary resec tion at Tokyo Women’s Medical University Hospital were investigated retrospectively. Forty (5.3%) of 758 patients had IIPs during the study period. Surgical indication of patients with simultaneous lung cancer and IIPs was the same as patients with lung cancer. Resected specimens were examined histopathologically, and histologic typing was done according to the World Health Organization/ International Association for the Study of Lung Cancer Histological Classification of Lung and Pleural Tumors. Sur gical-pathologic staging was performed according to the *Corresponding author. Tel.: +81-3-33538111 ext. 31125; fax: +81-352697333. E-mail address:
[email protected] (M. Kanzaki). 2011 Published by European Association for Cardio-Thoracic Surgery
sixth edition of the TNM Classification of Lung Cancer. This study was approved by the Tokyo Women’s Medical Univer sity Institutional Review Board for Clinical Research. Typically, the diagnosis of IIPs, in particular, idiopathic pulmonary fibrosis (IPF), was made either by surgical biopsy or bronchoscopic biopsy on the basis of pathological evi dence of usual interstitial pneumonia (UIP). When a biopsy was not carried out, clinical findings, such as fine crackles at the bilateral lower lung were double-checked by both a thoracic surgeon and a pulmonologist. The criteria for identifying IIPs on a chest computed tomography (CT)-scan or high-resolution computed tomography (HRCT)-scan were honeycomb formation, reticular shadow, and ground-glass opacity. When chest CT-scans IIPs findings, reviewed by a radiologist, were referred to a pulmonologist and the existence of IIPs was evaluated preoperatively. Preoperative evaluation included a complete history and physical examination, full blood count, biochemical profile, urine examination, arterial blood gas, pulmonary function test, 12-lead electrocardiogram, chest radiography, chest CT-scan, abdomen CT-scan, and brain magnetic resonance imaging (MRI). Predictive postoperative forced expiratory volume in 1 second (FEV1) with a formula based on the premise that the total number of subsegments was 42: postop FEV1 = [1 - (b - n)/(42 - n)] × (preop FEV1), where n and b are the number of obstructed subsegments and total subsegments, respectively, in the resected lobe [4]. If there was predicted postoperative FEV1
