Abstract
BackgroundPatients with idiopathic pulmonary fibrosis (IPF) have a high risk of developing lung cancer, but few studies have investigated the long-term outcomes of repeated surgery in such patients. The purpose of this study was to evaluate the surgical outcomes of repeated lung cancer surgery in patients with IPF.MethodsFrom January 2001 to December 2015, 108 lung cancer patients with IPF underwent pulmonary resection at two institutions; 13 of these patients underwent repeated surgery for lung cancer, and their data were reviewed.ResultsThe initial procedures of the 13 patients were lobectomy in 8, segmentectomy in 2, and wedge resection in 3. The subsequent procedures were wedge resection in 10 and segmentectomy in 3. The clinical stage of the second tumor was stage IA in 12 and stage IB in 1. Postoperatively, 3 patients (23.1%) developed acute exacerbation (AE) of IPF and died. The rate of decrease in percent vital capacity was significantly higher in patients with AE than in those without AE (p = 0.011). The 3-year overall survival rate was 34.6%. The causes of death were cancer-related in 7, AE of IPF in 3, and metachronous lung cancer in 1.ConclusionsDespite limited resection, a high incidence of AE was identified. The early and long-term outcomes of repeated surgery in lung cancer patients with IPF were poor because of the high risk of AE of IPF and lung cancer recurrence. Long-term intensive surveillance will be required to determine whether surgical intervention is justified in patients with multiple primary lung cancers and IPF.
Highlights
Patients with idiopathic pulmonary fibrosis (IPF) have a high risk of developing lung cancer, but few studies have investigated the long-term outcomes of repeated surgery in such patients
Long-term intensive surveillance will be required to determine whether surgical intervention is justified in patients with multiple primary lung cancers and IPF
The present analysis showed that the rate of %Percent vital capacity (VC) decrease was significantly higher in patients with acute exacerbation (AE) than in those without AE. %VC has been considered a reliable marker of fibrotic change [11, 13], and some previous studies [23, 25] reported that %VC had a significant and independent association with the development of AE
Summary
Patients with idiopathic pulmonary fibrosis (IPF) have a high risk of developing lung cancer, but few studies have investigated the long-term outcomes of repeated surgery in such patients. With regard to the outcome of surgical intervention, Sato et al BMC Pulmonary Medicine (2018) 18:134 several studies [9, 16, 17] reported 5-year survival rates of about 40% to 60% for stage I patients; surgical treatment for lung cancer with concomitant IPF might not be an absolute contraindication, as long as the patients are carefully selected. For lung cancer patients with IPF who undergo surgical interventions, many challenging problems, such as AE of IPF and high rates of second and third primary cancers, have been cited; to the best of our knowledge, there have been no studies focusing on the incidence of postoperative AE of IPF and the long-term outcome after a second pulmonary resection.
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