Acute exacerbation of idiopathic interstitial pneumonia following lung surgery in 3 of 68 consecutive patients: a retrospective study.
BACKGROUND
Acute exacerbation (AE) of idiopathic interstitial pneumonia (IIP) is occasionally observed after lung surgery. However, the risk of lung surgery in patients with IIPs is not yet clearly known.


METHODS
We conducted a retrospective study of consecutive patients who underwent lung surgery for cancer or for the diagnosis of interstitial pneumonia (IP) between 2000 and 2006. Patients who developed AE following the lung operation were assessed.


RESULTS
The data of 68 consecutive patients (males: 56, females: 12) with IP who underwent lung surgery were analyzed. The lung surgery included lobectomy for lung cancer in 48 patients [idiopathic pulmonary fibrosis (IPF) 31, non-IPF 17], and lung biopsy in 20 patients [IPF 8, non-specific interstitial pneumonia (NSIP) 8, unclassified 4]. Three patients with IPF (4.4% in total) developed AE after the operation (2 lobectomy, 1 biopsy). The triggers of AE were considered to be prolonged ventilation at a large tidal volume with oxygen supplementation at a high concentration. At the time of the AE, the extent of parenchymal involvement on the HRCT images was greater on the non-operated side. All three patients died of respiratory failure 12 to 82 days after the onset of AE despite corticosteroid therapy.


CONCLUSIONS
It is essential to be aware of the risk of AE of IPF following lung operation. Intraoperative respiratory management, such as oxygen supplementation at a high concentration and/or prolonged mechanical ventilation are likely possible etiologic factors.
Department of Respiratory Medicine, Toho University School of Medicine, Toho, Japan. susumu1029@gmail.com
Susumu
S
Sakamoto
Sakae
S
Homma
Mingyon
M
Mun
Takeshi
T
Fujii
Atsuko
A
Kurosaki
Kunihiko
K
Yoshimura
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D038481:Anterior Temporal Lobectomy / Q000009:adverse effects; D018450:Disease Progression; D005260:Female; D006801:Humans; D054988:Idiopathic Interstitial Pneumonias / Q000209:etiology / Q000473:pathology*; D008168:Lung / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology*; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors