Incidence of Acute Exacerbation of Interstitial Pneumonia in Operated Lung Cancer: Institutional Report and Review

Abstract

Purpose: Several small studies have reported that acute exacerbation (AE) of idiopathic interstitial pneumonia (IIP) can occur after lung resection for patients with non-small cell lung cancer, though the incidence rate is unclear. Methods: We examined our institutional data and performed a search of the MEDLINE database for publications regarding AE of IIP following surgery for lung cancer. Studies reporting the incidence rates of IIP and AE were included. Results: Eleven studies including our institutional data were determined to be eligible. Seven studies designated the incidence of IIP. Of 4749 patients (from 7 studies) who underwent lung resection for NSCLC, 277 had IIP, for an incidence rate of 5.8% (range 1.1%-11.7%). Eleven studies designated the incidence of AE from IIP patient, 67 (15.8%) of 424 IIP patients (from 11 studies) developed AE after surgery, of whom 38 (56.7%) died during the postoperative course. Conclusion: Coexistent IIP in patients with lung cancer increases the risk of lung cancer surgery. Furthermore, AE of IIP may be a major cause of operation-related death.

Study on Perioperative Administration of a Neutrophil Elastase Inhibitor for Interstitial Pneumonias

“…Second, the study population was treated at a single center and may therefore lack external validity. Only 2.3% of the IIP patients had acute exacerbation in this study; in contrast, previous studies have reported that acute exacerbation occurred in 9.3% to 15.8% of IIP patients [4,31]. This finding may be due to differences in the diagnostic criteria and perioperative management of IIPs among studies.…”

Impact of Pretreatment Interstitial Lung Disease on Radiation Pneumonitis and Survival after Stereotactic Body Radiation Therapy for Lung Cancer

“…[14][15][16] It has been reported that the presence of ILD increased the incidence of postoperative acute respiratory distress syndrome and acute exacerbations [17][18][19] and that ILD was a poor prognostic factor after surgery. [20][21][22][23][24] Thus, lung cancer patients with ILD are not good candidates for surgical resection.…”

Postoperative pyothorax a risk factor for acute exacerbation of idiopathic interstitial pneumonia following lung cancer resection

“…AE of IP has been shown to be a fatal postoperative morbidity [1][2][3][4][5][6], while BPF leading to PP has also been reported as a cause of postoperative death in Japanese patients [7]. The present findings indicate that IP is likely a risk factor for PP (borderline significance) and are the first to show that the presence of PP itself increases the risk of AE following lung cancer resection surgery.…”

“…Patients with IP comprise 4-5 % of those with lung cancer who undergo such an operation, while AE occurs in 9-15 % of patients with idiopathic IP undergoing lung cancer resection and the rate of mortality in those is approximately 50 % [4,5]. In Japan, AE is a major postoperative cause of death following lung resection, comprising 27.4 % of all perioperative mortality cases, while postoperative pyothorax (PP) and bronchopleural fistula (BPF) following lung cancer resection are the cause of perioperative death in 9.7 % of reported cases [7].…”

“…Acute exacerbation (AE) in patients with idiopathic interstitial pneumonia (IP), mostly comprised of idiopathic pulmonary fibrosis cases is a potentially fatal postoperative complication following lung surgery [1][2][3][4][5][6]. Patients with IP comprise 4-5 % of those with lung cancer who undergo such an operation, while AE occurs in 9-15 % of patients with idiopathic IP undergoing lung cancer resection and the rate of mortality in those is approximately 50 % [4,5].…”