title: Perioperative management of hepatectomy in patients with interstitial pneumonia: a report of three cases and a literature review.
abstract: OBJECTIVE
  Interstitial pneumonia (IP) is a progressive and irreversible fibrosis and can be fatal if acute exacerbation (AE) occurs. While a useful risk-scoring system has been established for lung surgery, no risk evaluation exists for AE of IP related to non-pulmonary surgery. The objective of this review is to describe the management for patients with IP.
  
  
  METHODS
  We experienced three hepatectomy cases with IP. The first was a 72-year-old male patient diagnosed with hepatocellular carcinoma. Preoperative computed tomography (CT) revealed IP with reticular shadow at the base of both lungs. After hepatectomy, his IP became acutely exacerbated and did not improve with steroid or sivelestat treatment. The second was a 74-year-old male patient diagnosed with hepatocellular carcinoma, and the third was a 75-year-old male patient with liver metastasis. In both these cases, CT revealed a reticular shadow in the lung fields, with increased serum KL-6 levels. We administered pirfenidone for perioperative management, during which time no respiratory complications occurred.
  
  
  RESULTS
  Perioperative management with pirfenidone for hepatectomy accompanied by IP was successful in our cases.
  
  
  CONCLUSIONS
  We reviewed reports on the perioperative prevention, intraoperative risk factors, and treatment of postoperative AE of IP and summarized the perioperative management techniques for IP patients undergoing non-pulmonary surgery.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.|Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Kubo
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan. karaki@gunma-u.ac.jp.|Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan. karaki@gunma-u.ac.jp.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Araki
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.|Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yamanaka
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
authors.forename: Kouki
authors.initials: K
authors.lastname: Hoshino
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.|Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Ishii
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.|Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Tsukagoshi
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
authors.forename: Takamichi
authors.initials: T
authors.lastname: Igarashi
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.|Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Watanabe
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Hirai
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.|Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan.
authors.forename: Fumiyoshi
authors.initials: F
authors.lastname: Saitoh
authors.affiliation: Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kuwano
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000601:surgery*; D018450:Disease Progression; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000556:secondary / Q000601:surgery*; D017563:Lung Diseases, Interstitial / Q000150:complications* / Q000175:diagnosis; D008297:Male; D018396:Mucin-1 / Q000097:blood; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control*; D011728:Pyridones / Q000008:administration & dosage*; D012120:Respiration Disorders / Q000209:etiology* / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; C060192:MUC1 protein, human; D018396:Mucin-1; D011728:Pyridones; C093844:pirfenidone
keywords: Abdominal surgery; Acute exacerbation; Hepatectomy; Interstitial pneumonia; Pirfenidone