Prediction of Acute Pulmonary Complications after Resection of Lung Cancer in Patients with Preexisting Interstitial Lung Disease

Abstract

Introduction: Interstitial lung disease (ILD) is associated with a high morbidity from acute pulmonary complications, such as acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), after pulmonary resection. This study attempts to uncover the risk factors for postoperative ALI/ARDS in lung cancer patients with ILD. Materials and Methods: We retrospectively reviewed 100 patients with ILD who underwent curative lung resection for lung cancer, from January 2000 to December 2008. Results: Of the 100 patients, 91 were male, and 9 were female. The median age was 66 years. Fifty-eight patients underwent a preoperative carbon monoxide diffusing capacity test (DLCo). Twelve pneumonectomies and 88 lobectomies were performed. Acute pulmonary complications were observed in 28 patients (13 with ALI and 15 with ARDS). Operative mortality was 14 %. Cause of death was due to respiratory failure from ALI/ARDS in all patients, except in one patient who died due to complications of acute renal failure. For all 100 patients, univariate analysis revealed that preexisting comorbidities, such as ischemic heart disease, renal failure, COPD, and neoadjuvant treatment for lung cancer, were risk factors for the development of postoperative ALI/ARDS. For the 58 patients who underwent preoperative DLCo testing, significant univariate risk factors included preexisting comorbidities and decreased DLCo. Multivariate analysis did not show any significant risk factors for ALI/ARDS. Conclusions: Preexisting comorbidities and decreased preoperative DLCo were the most significant risk factors for the development of acute pulmonary complications after pulmonary resection in patients with lung cancer and ILD.

Key words

pulmonary function - lung cancer treatment (surgery - medical) - surgery - complications

References

• 1 Daniels C E, Jett J R. Does interstitial lung disease predispose to lung cancer?.  Curr Opin Pulm Med. 2005;  11 431-437
• 2 Mizushima Y, Kobayashi M. Clinical characteristics of synchronous multiple lung cancer associated with idiopathic pulmonary fibrosis. A review of Japanese cases.  Chest. 1995;  108 1272-1277
• 3 Park J, Kim D S, Shim T S et al. Lung cancer in patients with idiopathic pulmonary fibrosis.  Eur Respir J. 2001;  17 1216-1219
• 4 Kawasaki H, Nagai K, Yokose T et al. Clinicopathological characteristics of surgically resected lung cancer associated with idiopathic pulmonary fibrosis.  J Surg Oncol. 2001;  76 53-57
• 5 Chiyo M, Sekine Y, Iwata T et al. Impact of interstitial lung disease on surgical morbidity and mortality for lung cancer: analyses of short-term and long-term outcomes.  J Thorac Cardiovasc Surg. 2003;  126 1141-1146
• 6 Takeda S, Maeda H, Sawabata N et al. Clinical impact of interstitial pneumonia following surgery for lung cancer.  Thorac Cardiovasc Surg. 2006;  54 268-272
• 7 Kawasaki H, Nagai K, Yoshida J, Nishimura M, Nishiwaki Y. Postoperative morbidity, mortality, and survival in lung cancer associated with idiopathic pulmonary fibrosis.  J Surg Oncol. 2002;  81 33-37
• 8 Chida M, Ono S, Hoshikawa Y, Kondo T. Subclinical idiopathic pulmonary fibrosis is also a risk factor of postoperative acute respiratory distress syndrome following thoracic surgery.  Eur J Cardiothorac Surg. 2008;  34 878-881
• 9 Kumar P, Goldstraw P, Yamada K et al. Pulmonary fibrosis and lung cancer: risk and benefit analysis of pulmonary resection.  J Thorac Cardiovasc Surg. 2003;  125 1321-1327
• 10 Watanabe S, Asamura H, Suzuki K, Tsuchiya R. Recent results of postoperative mortality for surgical resections in lung cancer.  Ann Thorac Surg. 2004;  78 999-1002
• 11 Suh R D, Goldin J G. High-resolution computed tomography of interstitial pulmonary fibrosis.  Semin Respir Crit Care Med. 2006;  27 623-633
• 12 Kishi K, Homma S, Kurosaki A, Motoi N, Yoshimura K. High-resolution computed tomography findings of lung cancer associated with idiopathic pulmonary fibrosis.  J Comput Assist Tomogr. 2006;  30 95-99
• 13 Bernard G R, Artigas A, Brigham K L et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination.  Am J Respir Crit Care Med. 1994;  149 818-824
• 14 Fujimoto T, Okazaki T, Matsukura T et al. Operation for lung cancer in patients with idiopathic pulmonary fibrosis: surgical contraindication?.  Ann Thorac Surg. 2003;  76 1674-1678
• 15 Watanabe A, Higami T, Ohori S, Koyanagi T, Nakashima S, Mawatari T. Is lung cancer resection indicated in patients with idiopathic pulmonary fibrosis?.  J Thorac Cardiovasc Surg. 2008;  136 1351-1363
• 16 Martinod E, Azorin J F, Sadoun D et al. Surgical resection of lung cancer in patients with underlying interstitial lung disease.  Ann Thorac Surg. 2002;  74 1004-1007
• 17 Nakajima J, Takamoto S, Murakawa T, Fukami T, Sano A. Is interstitial pneumonia in patients with collagen diseases a contraindication to lung cancer surgery?.  Surg Today. 2007;  37 14-18
• 18 Muraoka M, Tagawa T, Akamine S et al. Acute interstitial pneumonia following surgery for primary lung cancer.  Eur J Cardiothorac Surg. 2006;  30 657-662
• 19 Koizumi K, Hirata T, Hirai K et al. Surgical treatment of lung cancer combined with interstitial pneumonia: the effect of surgical approach on postoperative acute exacerbation.  Ann Thorac Cardiovasc Surg. 2004;  10 340-346
• 20 Kushibe K, Kawaguchi T, Takahama M, Kimura M, Tojo T, Taniguchi S. Operative indications for lung cancer with idiopathic pulmonary fibrosis.  Thorac Cardiovasc Surg. 2007;  55 505-508
• 21 Cherniack R M, Colby T V, Flint A et al. Correlation of structure and function in idiopathic pulmonary fibrosis.  Am J Respir Crit Care Med. 1995;  151 1180-1188
• 22 Erbes R, Schaberg T, Loddenkemper R. Lung function tests in patients with idiopathic pulmonary fibrosis. Are they helpful for predicting outcome?.  Chest. 1997;  111 51-57
• 23 Cerfolio R J, Talati A, Bryant A S. Changes in pulmonary function tests after neoadjuvant therapy predict postoperative complications.  Ann Thorac Surg. 2009;  88 930-935