Outcomes of lung cancer resection for patients with combined pulmonary fibrosis and emphysema.

Abstract

Combined pulmonary fibrosis and emphysema (CPFE) has recently been reported as a prognostic factor that may increase the risk of lung cancer for patients with respiratory disorders; however, there have been no reports published on mortality and morbidity following major lung resection for patients with CPFE. The subjects of this retrospective study were 1507 patients who underwent surgical resection of lung cancer at our institute between 2008 and 2013. We reviewed the computed tomography findings and divided the patients into four groups: CPFE group, fibrosis group, emphysema group, and normal group. The surgical outcomes of the patients with CPFE were compared with those of the patients in the other groups. The CPFE group comprised 137 (10.0%) patients. This group had worse surgical morbidity and mortality rates than either the fibrosis group or the emphysema group. The 90-day mortality rates for the CPFE, fibrosis, and emphysema groups were 7.3, 0, and 3.0%, respectively. A multivariate analysis of the CPFE group revealed that the distribution of IIP (HR 13.29, p=0.038) and blood loss (ml) (HR 1.001, p=0.013) predicted the hazard ratio for 90-day mortality. The postoperative outcome of patients with CPFE in this study was poor with respect to morbidity and mortality. The high rate of complications and poor survival warrants further investigation of the indications for surgery in patients with CPFE.