Abstract
Background: Operative morbidity in patients with lung cancer associated with perioperative interstitial pneumonia (IP) has emerged as a serious problem. Patients and Methods: We studied the clinical impact of perioperative related IP in 11 patients (IP group: 7 preoperative known, 4 acute onset) of 473 lung cancer patients who received a pulmonary resection. The IP group was compared to the remaining 462 patients (non-IP group). Demographic data, clinical presentation, and serum KL-6 levels were compared. Results: There were no differences in age, gender, type of surgery, and pulmonary function except for % DLco between the non-IP and IP groups. The IP group showed a higher in-hospital mortality (n = 2: 18.3 %) than that of the non-IP group (n = 3: 0.6 %) (p < 0.005). Seven patients with underlying IP with high KL-6 levels showed an uneventful recovery. Two patients with postoperative onset of acute IP had a fatal course associated with elevation of serum KL-6 levels. Conclusions: Postoperative development IP is a serious complication with high mortality, and serial measurement of KL-6 levels is useful to assess the activity of IP.
Key words
Lung cancer - interstitial pneumonia - acute interstitial pneumonia - adult respiratory distress syndrome (ARDS)
References
-
1
Kutlu C A, Williams E A, Evans T W, Pastorino U, Goldstraw P.
Acute lung injury and acute respiratory syndrome after pulmonary resection.
Ann Thorac Surg.
2000;
69
376-380
-
2
Wada H, Nakamura T, Nakamoto K, Maeda M, Watanabe Y.
Thirty day operative mortality for thoracotomy in lung cancer.
J Thorac Cardiovasc Surg.
1998;
115
70-73
-
3
Tanita T, Chida M, Hoshikawa Y. et al .
Experience with fetal interstitial pneumonia after operation for lung cancer.
J Cardiovasc Surg.
2001;
42
125-129
-
4
Watanabe S, Asamura H, Suzuki K, Tsuchiya R.
Recent results of postoperative mortality for surgical resections in lung cancer.
Ann Thorac Surg.
2004;
78
999-1003
-
5
Gross T J, Hunninghake G W.
Idiopathic pulmonary fibrosis.
New Engl J Med.
2001;
345
517-525
-
6
Nicholson A G, Colby T V, du Bois R M, Hansell D M, Wells A U.
The prognostic significance of the histologic pattern of interstitial pneumonia in patients presenting with the clinical entity of cryptogenic fibrosing alveolitis.
Am J Respir Crit Care Med.
2000;
162
2213-2217
-
7
Hubbard R, Venn A, Lewis S, Britton J.
Lung cancer and cryptogenic fibrosing alveolitis. A population-based cohort study.
Am J Respir Crit Care Med.
2000;
161
5-8
-
8
Matsushita H, Tanaka S, Saiki Y. et al .
Lung cancer associated with usual interstitial pneumonia.
Pathol Int.
1995;
45
925-932
-
9
Kondoh Y, Taniguchi H, Kawabata Y, Yokoi T, Suzuki K, Takagi K.
Acute exerbation in idiopathic pulmonary fibrosis: Analysis of clinical and pathologic findings in three cases.
Chest.
1993;
103
1808-1812
-
10
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
-
11
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
-
12
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
1674-1679
-
13
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
-
14
Bouros D, Nicholson A C, Polychronopoulos V, du Bois R M.
Acute interstitial pneumonia.
Eur Respir J.
2000;
15
412-418
-
15
Goto K, Kodama T, Sekine I. et al .
Serum levels of KL‐6 are useful biomarkers for severe radiation pneumonitis.
Lung Cancer.
2001;
34
141-148
-
16
Nakahara K, Monden Y, Ohno K, Maeda H, Kawashima Y.
A method for predicting postoperative lung function and its relation to postoperative complications in patients with lung cancer.
Ann Thorac Surg.
1985;
39
260-265
-
17
King T E, Costabel U, Cordier J F. et al .
Idiopathic pulmonary diagnosis and treatment: International consensus statement.
Am J Respir Crit Care Med.
2000;
161
646-664
-
18
Katzenstein A A, Myers J L.
Idiopathic pulmonary fibrosis. Clinical relevance of pathologic classification.
Am J Respir Crit Care Med.
1998;
157
1301-1315
-
19
Kobayashi J, Kitamura S.
KL‐6: A serum marker for interstitial pneumonia.
Chest.
1995;
108
311-315
-
20
Sakuma T, Takahashi K, Ohya N, Usuda K, Handa M.
Serum KL‐6, a novel mucin-like glycoprotein, as a indicator of intersitial pneumonitis following lobectomy.
Surg Today.
1999;
29
121-128
-
21
Greene K E, King Jr T E, Kuroki Y. et al .
Serum surfactant proteins-A and -D as biomarkers in idiopathic pulmonary fibrosis.
Eur Respir J.
2002;
19
439-446
-
22
Daniil Z D, Gilchrist F C, Nicholson A G. et al .
A histologic pattern of nonspecific interstitial pneumonia is associated with a better prognosis than usual interstitial pneumonia in patients with cryptogenic fibrosing alveolitis.
Am J Respir Crit Care Med.
1999;
160
899-905
-
23
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
-
24
Sato H, Callister M EJ, Mumby S. et al .
KL‐6 levels are elevated in plasma from patients with acute respiratory distress syndrome.
Eur Respir J.
2004;
23
142-145
-
25
Yaekashiwa M, Nakayama S, Ohnuma K. et al .
Simultaneous or delayed administration of hepatocyte growth factor equally represses the fibrotic changes in murine lung injury induced by bleomycin. A morphologic study.
Am J Respir Crit Care Med.
1997;
156
1937-1944
MD, PhD Shin-ichi Takeda
Toneyama National Hospital
Toneyama 5 - 1 - 1
Toyonaka 560-8552
Japan
Phone: + 81668532001
Fax: + 816 68 50 17 50
Email: stakeda@toneyama.hosp.go.jp