Surgical treatment of lung cancer combined with interstitial pneumonia: the effect of surgical approach on postoperative acute exacerbation.
Postoperative acute exacerbation of interstitial pneumonia (IP) is known to be a serious complication in the surgical treatment for primary lung cancer combined with IP. This retrospective study was conducted to investigate the influence of three different approaches to the thorax on postoperative acute exacerbation of IP in lung cancer patients. Forty-seven lung cancer patients who developed it underwent pulmonary resection between 1982 and 2003. Among them, approaches to the thorax consisted of posterolateral thoracotomy (PLT) (n=15), muscle-sparing thoracotomy (MST) (n=15), and video-assisted thoracic surgery (VATS) (n=17). Seven of 47 suffered from acute exacerbation of IP. Single variable analysis suggested that exertion dyspnea (Hugh-Jones classification), serum C-reactive protein, serum lactate dehydrogenase and total lung capacity were considered to be preoperative risk factors of acute exacerbation. As for the VATS patient, there was little frequency of postoperative complication in comparison with the other two approaches. However no significant difference was shown in the incidence of acute exacerbation between the three approaches.


CONCLUSIONS
The use of VATS did not prevent acute exacerbation of IP. However, the incidence of postoperative complications in VATS seemed to be low, therefore further trials are required.
Koizumi
Kiyoshi
K
Division of Thoracic Surgery, Department of Surgery II, Nippon Medical School, Tokyo, Japan.
Hirata
Tomomi
T
Hirai
Kyoji
K
Mikami
Iwao
I
Okada
Daisuke
D
Yamagishi
Shigeki
S
Kawashima
Tetsuo
T
Nakajima
Yuki
Y
Shimizu
Kazuo
K
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D017563:Lung Diseases, Interstitial / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D011237:Predictive Value of Tests; D012008:Recurrence; D012129:Respiratory Function Tests; D012307:Risk Factors; D016019:Survival Analysis; D013908:Thoracotomy / Q000009:adverse effects; D014109:Total Lung Capacity; D016896:Treatment Outcome