Lobe-specific outcomes of surgery for lung cancer patients with idiopathic interstitial pneumonias

• Published in: General thoracic and cardiovascular surgery 2020-08, Vol.68 (8), p.812-819
• Main Authors: Fukui, Mariko, Takamochi, Kazuya, Suzuki, Kazuhiro, Hotta, Akihiro, Ando, Katsutoshi, Matsunaga, Takeshi, Oh, Shiaki, Suzuki, Kenji
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antigens; Cancer therapies; Cardiac Surgery; Cardiology; Dyspnea; Emphysema; Female; Humans; Hypoxia; Idiopathic Interstitial Pneumonias - complications; Idiopathic Interstitial Pneumonias - mortality; Investigations; Lung - physiopathology; Lung - surgery; Lung cancer; Lung diseases; Lung Neoplasms - complications; Lung Neoplasms - mortality; Lung Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Original Article; Ostomy; Pneumonia; Postoperative Period; Prognosis; Pulmonary Emphysema - complications; Pulmonary Emphysema - mortality; Pulmonary fibrosis; Respiratory Function Tests; Retrospective Studies; Surgical Oncology; Surgical outcomes; Thoracic Surgery; Tomography; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-019-01277-2

Objective Idiopathic interstitial pneumonias (IIPs) are predominantly encountered in the lower lobe, and frequently with concomitant emphysema that is predominantly in the upper lobe. However, the impact of the resection site on surgical outcomes of lung cancer with IIPs remains unclear. This study was conducted to evaluate the surgical outcome between patients undergoing upper or lower lobe resection. Methods This retrospective study was performed on 1972 patients who underwent surgical resection for lung cancer at our institute between 2009 and 2018. Review of CT findings revealed that 337 (14.1%) patients had IIPs. Morbidity, mortality, and postoperative pulmonary function test (PFT) were compared between patients who underwent upper or lower lobectomy and stratified by presence or absence of emphysema (CPFE and non-CPFE). Results Surgical mortality and morbidity were not statistically different between the two groups regardless of CPFE. The difference between actual and predicted postoperative PFTs was statistically larger in the upper lobectomy compared to the lower lobectomy among the non-CPFE patients. (FVC: p  = 0.019, FEV 1.0 : p  = 0.001, %DLCO: p  = 0.090) Conclusions Site of the resected lobe in lung cancer is not a prognostic factor of surgical mortality and morbidity in patients with IIPs. However, the impact of upper lobectomy on postoperative respiratory function reduction is larger than lower lobectomy in non-CPFE patients.