Distribution of interstitial pneumonia: a new radiological predictor of 90-day mortality after resection of lung cancer.

Abstract

Surgery for lung cancer complicated by idiopathic interstitial pneumonia (IIP) is associated with a high rate of postoperative mortality. Thus, preoperative predictors of surgical mortality are needed to aid in the selection of suitable surgical candidates. The subjects of this retrospective study were 1625 patients who underwent resection of primary lung cancer between 2000 and 2012, 203 (12.5%) of whom were found to have IIPs. The following radiological findings were also evaluated: presence of honeycombing and the distribution (diffuse or localized) and extension (central extension or peripheral localized) of honeycombing or infiltration. We also investigated clinical factors and conducted multivariate analyses to identify the predictors of surgical mortality. The 30- and 90-day mortality rates were 0.5 and 1.4% overall and 1.6 and 6.4% in the IIP patients, respectively. Multivariate analysis revealed that a preoperative pO2<70mmHg (HR 15.3), diffuse distribution and central extension of interstitial pneumonia on computed tomography (HR 9.2), and operative blood loss (ml: HR 1.003) were significant predictors of 90-day mortality. Diffuse distribution and central extension of IIPs, as well as preoperative hypoxia and operative blood loss, were significant predictors of 90-day mortality.