OJRD  Vol.4 No.2 , May 2014
Risk Factors for Postoperative Acute Exacerbation of Idiopathic Interstitial Pneumonia Following Surgery for Primary Lung Cancer
Abstract: Objective: Postoperative acute exacerbation of idiopathic interstitial pneumonia (IIP) is a serious complication in patients with lung cancer. This study was aimed to investigate risk factors for postoperative acute exacerbation of IIP in surgery for primary lung cancer. Method: We evaluated retrospectively 37 IIP patients combined with primary lung cancer who underwent lung resection for lung cancer from January 2006 and March 2010. Preoperative and perioperative clinical data were collected and analyzed. Results: Ten of 37 patients (27.0%) developed acute exacerbation of IIP after surgery for primary lung cancer and five patients (13.5%) died of progressive respiratory failure. There was no significant difference in preoperative clinical factors between acute exacerbation (AE) group and non-acute exacerbation (non-AE) group. In perioperative factors, the duration of anesthesia is significantly longer in AE group than in non-AE group. Conclusion: These data suggest that it is unable to predict postoperative acute exacerbation of IIP from preoperative clinical data. Perioperative and postoperative management might be important to prevent acute exacerbation of IIP combined lung cancer.
Cite this paper: Tanaka, T. , Abe, S. , Hayashi, H. , Kamio, K. , Saito, Y. , Usuki, J. , Azuma, A. , Mikami, I. , Haraguchi, S. , Koizumi, K. , Usuda, J. and Gemma, A. (2014) Risk Factors for Postoperative Acute Exacerbation of Idiopathic Interstitial Pneumonia Following Surgery for Primary Lung Cancer. Open Journal of Respiratory Diseases, 4, 48-54. doi: 10.4236/ojrd.2014.42008.

[1]   Tanita, T., Chida, M., Hoshikawa, Y., Handa, M., Sato, M., Sagawa, M., Ono, S., Matsumura, Y., Kondo, T. and Fujimura, S. (2001) Experience with Fatal Interstinal Pneumonia after Operation for Lung Cancer. The Journal of Cardiovascular Surgery, 42, 125-129.

[2]   Hubbard, R., Venn, A., Lewis, S. and Britton, J. (2000) Lung Cancer and Cryptogenic Fibrosing Alveolitis. A Population-Based Cohort Study. American Journal of Respiratory and Critical Care Medicine, 161, 5-8.

[3]   Kasawaski, H., Nagai, K., Yoshida, J., Nishimura, M. and Nishiwaki, Y. (2002) Postoperative Morbidity, Mortality, and Survival in Lung Cancer Associated with Idiopathic Pulmonary Fibrosis. Journal of Surgical Oncology, 81, 33-37.

[4]   Chida, M., Ono, S., Hoshikawa, Y. and Kondo, T. (2008) Subclinical Idiopathic Pulmonary Fibrosis Is Also a Risk Factor of Postoperative Acute Respiratory Distress Syndrome Following Thoracic Surgery. European Journal Cardio-Thoracic Surgery, 34, 878-881.

[5]   Saito. H., Minamiya, Y., Nanjo, H., Ito, M., Ono, T., Motoyama, S., Hashimoto, M. and Ogawa, J. (2011) Pathological Finding of Subclinical Interstitial Pneumonia as a Predictor of Postoperative Acute Respiratory Distress Syndrome after Pulmonary Resection. European Journal Cardio-Thoracic Surgery, 39, 190-194.

[6]   Sakamoto, S., Homma, S., Mun, M., Fujii, T., Kurosaki, A. and Yoshimura, K. (2011) Acute Exacerbation of Idiopathic Interstitial Pneumonia Following Lung Surgery in 3 of 68 Consecutive Patients. Internal Medicine, 50, 77-85.

[7]   Yano, M., Sasaki, H., Moriyama, S., Hirosaka, Y., Yokota, K., Kobayashi, S., Hara, M. and Fujii, Y. (2012) Post-Operative Acute Exacerbation of Pulmonary Fibrosis in Lung Cancer Patients Undergoing Lung Resection. Interactive CardioVasc Thoracic Surgery, 14, 146-150.

[8]   Mizuno, Y., Iwata, H., Shirahashi, K., Takamochi, K., Oh, S., Suzuki, K. and Takemura, H. (2012) The Importance of Intraoperative Fluid Balance for the Prevention of Postoperative Acute Exacerbation of Idiopathic Pulmonary Fibrosis after Pulmonary Resection for Primary Lung Cancer. European Journal Cardio-Thoracic Surgery, 41, e161-e165.

[9]   American Thoracic Society/European Respiratory Society (2002) American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. American Journal of Respiratory and Critical Care Medicine, 165, 277-304.

[10]   American Thoracic Society (2000) Idiopathic Pulmonary Fibrosis: Diagnosis and Treatment: International Consensus Statement. American Journal of Respiratory and Critical Care Medicine, 161, 646-664.

[11]   Seo, Y., Abe, S., Kurahara, M., Okada, D., Saito, Y., Usuki, J., Azuma, A., Koizumi, K. and Kudo, S. (2006) Beneficial Effect of Polymyxin B-Immobilized Fiber Column (PMX-DHP) Hemoperfusion Treatment on Acute Exacerbation of Idiopathic Pulmonary Fibrosis. Results of a Pilot Study. Internal Medicine, 45, 1033-1038.

[12]   Shintani, Y., Ohta, M., Iwasaki, T., Ikeda, N., Tomita, N., Kawahara, K. and Ohno, Y. (2001) Predictive Factors for Postoperative Acute Exacerbation of Interstitial Pneumonia Combined with Lung Cancer. General Thoracic and Cardiovascular Surgery, 58, 182-185.

[13]   Danner, B.C., Didilis, V.N., Wiemeyer, S., Stojanovic, T., Kitz, J., Emmert, A., Fuzesi, L. and Schondube, F.A. (2010) Long-Term Survival Is Linked to Serum LDH and Partly to Tumor LDH-5 in NSCLC. Anticancer Research, 30, 1347- 1351.

[14]   Fujiwara, Y., Kiura, K., Toyooka, S., Hotta, K., Tabata, M., Takigawa, N., Soh, J., Tanimoto, Y., Kanehiro, A., Kato, K., Date, H. and Tanimoto M. (2008) Elevated Serum Level of Sialylated Glycoprotein KL-6 Predicts a Poor Prognosis in Patients with Non-Small Cell Cancer Treated with Gefitinib. Lung Cancer, 59, 81-87.

[15]   Izumi, Y., Gika, M., Kohno, M., Kikuchi, K. and Kobayashi, K. (1997) Surgical Resection for Lung Cancer Patients with Idiopathic Interstitial Pneumonia. Lung Cancer, 18, 113-114.

[16]   Fulmer, J.D., Roberts, W.C., Von Gal, E.R. and Crystal, R.G. (1979) Morphogic-Physiologic Correlates of the Severity of Fibrosis and Degree of Cellularity in Idiopathic Pulmonary Fibrosis. Journal of Clinical Investigation, 63, 665-676.

[17]   King, Tr. T.E. (2011) Idiopathic Pulmonary Fibrosis. Interstitial Lung Disease 5th Edition. People‚Äôs Medical Publishing House-USA, Shelton.

[18]   Okada, D., Koizumi, K., Kawamoto, M., Hemmi. S., Hirai, K., Mikami, I., Tanaka, S., Azuma, A., Kudo, S. and Fukuda, Y. (2002) Clinicopathologic Considerations of Postoperative Acute Exacerbation in Patients with Idiopatic Interstinal Pneumonia Combined with Lung Cancer. Japanese Journal of Lung Cancer, 42, 567-572.

[19]   Tiitto, L., Bloigu, R., Heiskanen, U., Paakko, P., Kinnula, V.L. and Wiik, R.K. (2006) Relationship between Histopathological Features and the Course of Idiopathic Pulmonary Fibrosis/Usual Interstitial Pneumonia. Thorax, 61, 1091- 1095.

[20]   Jeon, K., Yoon, J.W., Sun, G.Y., Kim, J., Kim, K., Yang, M., Kim, H., Kwon, O.J. and Shim, Y.M. (2009) Risk Factors for Post-Pneunectomy Acute Lung Injury/Acute Respiratory Distress Syndrome in Primary Lung Cancer Patients. Anaesthesia and Intensive Care, 37, 14-19.

[21]   Shilling, T., Kozian, A., Huth, C., Buhling, F., Kretzschmar, M., Welte, T. and Hachenberg, T. (2005) The Pulmonary Immune Effect of Mechanical Ventilation in Patients Undergoing Thoracic Surgery. Anesthesia & Analgesia, 101, 957-965.

[22]   Zeldin, R.A., Normandin, D., Landtwing, D. and Peters, R.M. (1984) Postpneumonectomy Pulmonary Edema. The Journal of Thoracic and Cardiovascular Surgery, 87, 359-365.

[23]   Muraoka, M., Akamine, S., Tsuchiya, S., Kabahara, R., Morino, S., Mochinaga, H., Yamaoka, N. and Uchiyama, Y. (2007) The Efficacy of Perioperative Administration of Steroid and Erythromycin in the Surgery for Lung Cancer Complicated with Interstinal Pneumonia. Kyobu Geka, 60, 871-878.

[24]   Tanaka, A., Harada, R., Muraki, S., Yamauchi, A. and Osawa, H. (2005) Prevention of Acute Exacerbation of Interstinal Pneumonia in the Patients Operated for Lung Cancer. Kyobu Geka, 58, 41-45.

[25]   Licker, M., Perrot, M.D., Spiliopoulos, A., Robert, J., Diaper, J., Chevalley, C. and Tschopp, J.M. (2003) Risk Factors for Acute Lung Injury after Thoracic Surgery for Lung Cancer. Anesthesia & Analgesia, 97, 1558-1565.