Pulmonary Resection For Lung Cancer Research Articles

The Athens uniportal video-assisted thoracic surgery masterclass-an ambitious kickstarter.

The shift from open to minimally invasive techniques in thoracic surgery has been dramatic during the past 10 years. Not only the feasibility, safety, reproducibility and oncologic efficacy of these techniques have been clearly demonstrated, but also their superiority concerning mortality, postoperative pain, postoperative quality of life and recovery. Thus, video-assisted thoracic surgery (VATS) is currently the procedure of choice for a wide variety of thoracic interventions, ranging from major pulmonary resections for lung cancer to thymectomy and mediastinal procedures, even to esophageal procedures. Amongst the various minimally invasive techniques, the uniportal or single incision VATS has recently gained great popularity. The concept of a single 2.5 cm incision, despite not being the technique's only advantage, through which major thoracic procedures can be carried out, seems to greatly appeal to surgeons throughout the globe. Appealing as it may be, the technique is also demanding, revealing the need for training. A well organised and structured, fee free training programme that has been running at the Shanghai Pulmonary Hospital for more than 2 years under the inspirational guidance of Dr. Gonzalez Rivas has undoubtedly skyrocketed the technique's adoption worldwide. Of equal significance towards the spread of the technique have proved to be the master classes, 2-day intensive tutorials, hosted by centres all over the world during which Dr Rivas outlines the principles of the technique before performing with the assistance of the local surgical team. We hereby reflect on the experience obtained following Riva's visit to our institution in Athens, Hellas (Greece) for a 2-day uniportal VATS master class, the first held in Hellas.

Study on Perioperative Administration of a Neutrophil Elastase Inhibitor for Interstitial Pneumonias

Although acute exacerbation of idiopathic interstitial pneumonias (IIPs) is a lethal complication after pulmonary resection for lung cancer with IIPs, there are no established methods to prevent its occurrence. This prospective randomized study was conducted to evaluate whether perioperative administration of the neutrophil elastase inhibitor sivelestat prevents acute exacerbation after surgery. The IIP patients with suspected lung cancers were randomly assigned to two groups before surgery: in group A (n= 65), sivelestat was perioperatively administered for 5 days; in group B (n= 65), no medications were administered. The primary endpoint was the frequency of acute exacerbation of IIPs. The secondary endpoints were perioperative changes in the lactate dehydrogenase, C-reactive protein, sialylated carbohydrate antigen, surfactant protein D and surfactant protein A values, and the safety of preoperative administration of sivelestat. Multivariate analyses were performed using a logistic regression model to identify the factors that predicted acute exacerbation. Acute exacerbation developed in 2 patients in group A and 1 patient in group B (p= 0.559). Administration of sivelestat did not contribute to decreasing the acute exacerbation as well as short- and long-term mortality. The differences were not statistically significant in perioperative lactate dehydrogenase, C-reactive protein, sialylated carbohydrate antigen, and surfactant protein D and A levels. No subjective adverse events were observed. A preoperative partial pressure oxygen level of less than 70 mm Hg was the only predictive factor identified in the logistic analysis (p= 0.019, hazard ratio 19.2). Perioperative administration of neutrophil elastase inhibitor appeared to be safe; however, it could not prevent the development of acute exacerbation after surgery in lung cancer patients with IIPs.

Minimally Invasive and Open Approaches to Mediastinal Nodal Assessment

There is no consensus on mediastinal lymph node dissection versus sampling for early-stage lung cancer. There are also mixed data on the ability to remove an adequate number of lymph nodes by a minimally invasive approach. In this review, we discuss the difference between dissection and sampling, what circumstances dictate the use of one or the other during an anatomic pulmonary resection for lung cancer, and when it is appropriate to use minimally invasive versus open approaches in the assessment of mediastinal nodes.

P1.08-004 Prediction of Surgical Outcome by Modeling Based on Risk Factors of Morbidity Following Pulmonary Resection for Lung Cancer in the Elderly

Surgical treatment for elderly patients with lung cancer presents more challenges compared with general population. The aim of the study was to predict surgical outcome following pulmonary resection in the elderly with lung cancer by developing a clinical model. Clinical records of 525 patients aged over 70 years who underwent pulmonary resection for lung cancer in a single center were reviewed. Patients were divided into three ordered categories of surgical outcome according to the Clavien–Dindo classification. Using a development cohort of 401 patients, an ordinal logistic regression was performed to develop a prediction model for surgical outcome. The model was internally validated by bootstrap method and externally validated by another cohort of 124 patients. Two previous models were tested as benchmarks of our model. The model was developed based on five risk factors of morbidity: ASA classification (p<0.001), pulmonary disease (p=0.001), tumor size (p=0.011), tumor location (p=0.015) and surgical approach (p=0.036). C-statistics of the model was similar to bootstrapping one. Hosmer-Lemeshow test showed a good goodness-of-fit. In external validation the performance of our model was superior to the two previous models.Tabled 1Prediction Performance of the Present and Previous ModelsModelsc-statistic (95%CI)Hosmer-Lemeshow testThe present model0.75 (0.69-0.80)0.674After bootstrapping0.75 (0.68-0.80)0.671External validation0.70 (0.64-0.75)0.382Kates M, et al (2009)0.63 (0.57-0.69)0.115Poullis M, et al (2013)0.61 (0.54-0.67)0.091 Open table in a new tab Our model displayed an acceptable ability to predict surgical outcome in elderly patients undergoing pulmonary resection for lung cancer.

P1.08-011 Feasibility of Surgical Resection for Lung Cancer Patients Aged over 85 Years

Pulmonary resections for lung cancer in patients aged 80 years or over have been increasing in the aging society, which are accounted for approximately 10% in Japan. Due to the prolonged life expectancy in the elderly, it is inevitable to assess the feasibility of pulmonary resection for lung cancer especially in patients over 85 years in age. From 1995 to 2015, we underwent 3,099 pulmonary resections for lung cancers in our department. Among them, 213 (6.8%) were aged 80 years or older. They were divided into 2 groups based on the age, i.e., “Over80” who were aged from 80 to 84 and “Over85” who were aged 85 or elder. Clinicopathological factors were analyzed between these two groups, using the t-test or the Chi-squared test. Survivals were calculated by Kaplan-Meier estimation methods. Of the cases, 174 (84%) showed Over80 and 39 (18%) showed Over85. The proportions for male, comorbidity rate, c-stage I disease in the Over85 group were not significantly different than those of the Over80 group (age; 20 (51%) vs. 105 (60%), p=0.189: comorbidity; 36 (92%) vs. 154 (89%), p=0.489: c-stage I; 36 (92%) vs. 143 (82%), p=0.119). The surgical candidates of the octogenarian included 167 (78%) radiological pure-solid lung cancer, however, there was not significant difference between the 2 groups (28 (72%) vs. 139 (80%), p=0.267). Lobectomy was equally performed in 28 (72%) on the Over85 and 126 (72%) of the Over80 (p=0.938), respectively. Perioperative morbidities were observed in 104 (48%) of the patients, though, significant difference was not found between the two study arms (84 (48%) vs. 20 (51%), p=0.734) and the 30-day mortality rates was observed just one patient for the Over80 group. The 5-year overall survival was 51.1% in the Over80 group, 62.6% in the Over85 group (p=0.275), respectively. In the octogenarians, a patient with radiological pure-solid lung cancer was more common as a surgical candidate for the definitive local management. Although proper patient selection and meticulous perioperative management were mandatory for surgical resection of the very elderly, our results support the finding that radical surgical intervention could be feasible even for the patients with high age over 85 years.

P1.05-079 Lung Cancer in the Elderly: Factors Affecting Long-Term Survival Following Resection

Lung Cancer remains the most common cancer in the world. It has progressively become a disease of older people, with the median age at diagnosis now exceeding 65 years. As population grows older demographically, it poses various distinct treatment & management challenges. Thus, we looked into factors associated with long-term survival following pulmonary resections for lung cancer in the elderly patients 70 years or older. All medical records for these elderly patients with lung cancer who underwent pulmonary resections, between years 2000 to 2010, were reviewed. These data was cross-referenced & checked with the operating theatre ORSOS & national mortality data. Patients were stratified into various groups. Gender, Median age at diagnosis, patient characteristics, associated medical co-morbidities, Pre-operative lung functions tests, extend of pulmonary resections & overall 1, 2 & 5 years survival was calculated. Stringent & proper selection criteria in elderly patient with lung cancer undergoing pulmonary resections will identify groups of patients that will benefit from these surgeries . Thus, identifying these elderly sub-groups will give new lease of life in survivability following pulmonary resections for lung cancer.

P1.08-077 Comparison of Pulmonary Resection for Lung Cancer after Radical Chemoradiation with That after Induction Chemoradiation

Induction chemoradiation (ICR) for advanced non-small cell lung cancer is often limited to 45Gy or less to avoid increase of perioperative complications. On the other hand, pulmonary resection after definitive chemoradiotherapy (DCR) is increasing. In this study, we compared three groups, pulmonary resection following low dose ICR (LCR), that following high dose ICR (HCR) and that after DCR. From 1997 to 2015, we had 24 pulmonary resections following CR. Among 13 ICR, 7 were LCR and 6 were HCR. There were 11 DCR. Intercostal muscle flaps were used in 1 LCR, 6 HCR and 1 DCR. Omental flaps were used in 8 DCR. There was no mortality in any groups. In comparison with LCR and HCR, operation time (min) were 352 and 344, estimated blood loss (ml) were 440 and 280, morbidity (%), 86 and 50. Although operation time was longer (470 min) and there were more blood loss (820 ml) in DCR, there was no significant increase of peri- and post-operative complications. 2-year recurrence free survival and 5-year overall survival rates (%) were 43 and 29 in LCR, 40 and 60 in HCR, and 58 and 52 in DCR. High dose ICR may contribute to better local control and longer survival. Pulmonary resection after DCR is as safe as that following ICR.

P1.03-026 Measurement of Pulmonary Artery on CT to Predict Acute Exacerbation of Interstitial Pneumonia after Pulmonary Resection for Lung Cancer

P1.03-026 Measurement of Pulmonary Artery on CT to Predict Acute Exacerbation of Interstitial Pneumonia after Pulmonary Resection for Lung Cancer

P2.07-009 Lung Function after Pulmonary Resection in Lung Cancer: Topic: Research, Audits

Surgical resection for lung cancer reduces the pulmonary capacity relative to the extent of the resection. The forced expiratory volume in the first second (FEV1) correlates significant to the experience of dyspnoea and lung function by the patient. In this study we analysed changes in FEV1 over time after lung surgery to investigate if standard rehabilitation has an effect on lung function. Furthermore we analysed the effect of physical exercise using the 6 minute walk test (6MWT) before and after a standardized physical exercise program. FEV1 is measured in 225 pulmonary resections (175 lobectomies, 31 pneumonectomies, 17 resections and 2 explorative thoracotomies) performed in a single surgical unit. FEV1 is measured before surgery and after 1, 2, 6 and 12 months. All patients are alive after 1 year. Patients were treated in accordance with national guidelines and 131 patients received oncologic treatment during the first year after surgery. Patients were postoperatively offered to join a physical lung rehabilitation program starting 3 to 6 weeks after surgery twice a week for 4 – 10 weeks. Median distance traveled after 6 minutes was 484 meters before the exercise program and 557 meters after. Change is significant; P= 0,0001, paired T test). A significant reduction in FEV1 before and one month after surgery was observed, but between one month and one year after surgery no significant change was observed. As expected FEV1 declines after pulmonary resection for lung cancer. Physical exercise in a standardized rehabilitation program has a positive effect on the short term physical capability of the patient, but this effect is not reflected in the long term lung function test. Short intensive physical exercise after pulmonary resection in lung cancer will have an effect but sustained effects calls for fundamental and persistent efforts.

P3.04-030 Examination of the Relevance of Prolonged Air Leakage after Pulmonary Resection for Lung Cancer and Factors Affecting Delayed Wound Healing: Topic: Miscellaneous II

The management of prolonged air leakage (PAL), a common complication that occurs in 8% to 26% of patients undergoing pulmonary resection, is difficult in many cases, and is also associated with other complications. Blood coagulation factor XIII (BCFXIII) is known to play a role in wound healing. However, little is known about the role of BCFXIII in the field of thoracic surgery. We examined the association between BCFXIII and PAL, chronic obstructive pulmonary disease (COPD) and PAL, and total protein (TP; an index of nutrition) and PAL. This study included 43 patients with primary lung cancer who underwent pulmonary resection in our institution and developed air leakage for at least 3 days postoperatively. All patients agreed to measurement of their plasma BCFXIII levels. BCFXIII, TP, and pulmonary function were measured within 1 month preoperatively. TP and BCFXIII were measured 5 days after surgery. The t-test was used for statistical analysis. The mean duration of drainage was 6.3±3.2 days in patients with a postoperative BCFXIII level of >70% and 8.8±4.2 days in those with a postoperative BCFXIII level of ≤70%. Patients with postoperative BCFXIII ≤70% (n=11) required drain placement for a significantly longer period (p=0.049). The mean duration of drainage was 6.3±3.2 days in patients with forced expiratory volume 1.0% (FEV1.0%) ≥70% and 8.8±4.0 days in those with FEV1.0% <70% (n=11). Patients with FEV1.0% <70% required drain placement for a significantly longer period (p=0.038). Our analysis did not find a significant difference in the duration of drainage in relation to nutritional status in groups with postoperative TP ≥6.6 g/dl and <6.6 g/dl (n=35). However, the postoperative BCFXIII levels were significantly lower in patients with low postoperative TP levels (BCFXIII 79±16%) than in those with normal postoperative TP levels (BCFXIII: 96±23%) (p=0.033). Our results suggest that low BCFXIII levels may be associated with PAL. Moreover, we found COPD to be closely related to PAL. No significant difference was noted in the duration of drainage between normal and low-nutrition patients. However, poor nutrition may have an effect on PAL as a result of decreased BCFXIII level.

Feasibility of Pulmonary Resection for Lung Cancer in Patients With Coronary Artery Disease or Atrial Fibrillation

The aim of this study was to clarify the outcomes of lung resection for lung cancer in patients with cardiac disease, especially coronary artery disease, in a large-scale multi-institutional cohort. We retrospectively analyzed the data on 1,254 patients who underwent major lung resection for lung cancer and had been diagnosed with coronary stenosis, atrial fibrillation, or both, in 58 institutions in Japan between January 2009 and December 2011. The primary outcome was 90-day postoperative mortality or in-hospital death. Among the 1,254 patients, 902 (71.9%) and 452 patients (36.0%) were preoperatively diagnosed with coronary stenosis and atrial fibrillation, respectively, and 951 patients (75.8%) received antiplatelet therapy. Among the patients with coronary stents (n= 532; 42.4%), 204 (16.3%) received drug-eluting stents. The 90-mortality or in-hospital death rate was 2.6% (n= 32), including stent thrombosis (n= 1), thromboembolic events without stent thrombosis (n= 2), and bleeding events (n= 2). In the multivariate analyses, blood transfusion, history of cerebrovascular disease, amount of bleeding, and history of congestive heart failure were associated with a higher independent risk of 90-day mortality or in-hospital death (odds ratio, 9.400, 3.574, 2.827, and 2.945, respectively). Preoperative discontinuation of antiplatelet therapy was not associated with an independent risk of 90-day mortality or in-hospital death on univariate analysis. Major lung resection for lung cancer in patients with coronary artery disease is feasible. Our study suggests that discontinuation of antiplatelet therapy may not increase postoperative complications in patients with coronary artery disease.

肺癌手術中に合併した腫瘍塊による対側気管支閉塞の 2 救命例

肺癌手術中に合併した腫瘍塊による対側気管支閉塞の 2 救命例

Efficacy of Ramelteon for delirium after lung cancer surgery.

The aim of the study was to evaluate the feasibility of Ramelteon for the prevention of delirium after lung cancer surgery in elderly patients. Medical records of patients over 70 years old, who underwent anatomical pulmonary resection for lung cancer at our institution from January 2013 to December 2015, were reviewed. Patients treated in 2013 and 2014 were used as a control group. Ramelteon was administered daily for 7 days after surgery. The incidence of delirium was determined based on the Intensive Care Delirium Screening Checklist (ICDSC). Scores of ≥4 and 1-3 points were used for the diagnoses of delirium and a pre-delirious state, respectively. There were 24 patients in the Ramelteon group and 58 patients in the control group. ICDSC scores of ≥4 points were found for no patients in the Ramelteon group and 5 (9%) in the control group, whereas 21 (88%) and 49 (85%) patients, in the respective groups, had ICDSC scores of 0 points. The average incidence of events, associated with delirium, showed a trend of being lower in the Ramelteon group (0.25 ± 0.74 vs 1.58 ± 4.93, P = 0.061), and all events in the Ramelteon group occurred on the day of surgery. Thus, only one day was required for complete recovery from delirium in the Ramelteon group, whereas 8 days were needed in the control group. The peak delirious state occurred after 5 days in the control group. Ramelteon is likely to reduce the incidence and intensity of delirium after surgery for lung cancer in elderly patients.

A propensity matched comparison of effects between video assisted thoracoscopic single-port, two-port and three-port pulmonary resection on lung cancer.

To summarize our experiences of single-port, two-port vs. three-port VATS pulmonary resection for lung cancer patients. Data of consecutive 1,553 patients who underwent video assisted thoracoscopic surgery (VATS) pulmonary resection for lung cancer in the Department of Thoracic Surgery of Cancer Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College between November 2014 and January 2016 were prospectively collected and analyzed. A propensity-matched analysis was used to compare the short-term outcomes of lung cancer patients who received VATS single-port, two-port and three-port pulmonary resection. There were 716 males and 837 females. The mean age was 58.90 years (range, 25-82 years) and the conversion rate was 2.7% (42/1,553) in this cohort. After propensity score matching, there were 207 patients in single-port and two-port group, and 680 patients in three-port group. Propensity-matched analysis demonstrated that there were no significant differences in duration of operation (129 vs. 131 min, P=0.689), intra-operative blood loss (63 vs. 70 mL, P=0.175), number of dissected lymph nodes (12 vs. 13, P=0.074), total hospital expense (﹩9,928 vs. ﹩9,956, P=0.884) and cost of operation (﹩536 vs. ﹩535, P=0.879) between VATS single-port, two-port and conventional three-port pulmonary resection groups. There was no significant difference in the complication rate between two groups (5.3% vs. 4.7%, P=0.220). However, compared with three-port group, patients who underwent single port and two-port experienced shorter postoperative length of stay (6.24 vs. 5.61 d, P=0.033), shorter duration of chest tube (4.92 vs. 4.25 d, P=0.008), and decreased volume of drainage (926 vs. 791 d, P=0.003). The short term outcomes between VATS single-port, two-port and conventional three-port groups for the surgical treatment of lung cancer were comparable. However, compared with three-port VATS pulmonary resection, single-port and two-port were associated with shorter postoperative length of stay, shorter duration of chest tube, and decreased volume of drainage.

Efficacy and safety of Innoseal for air leak after pulmonary resection: a case-control study

BackgroundProlonged air leak is one of the most common complications after lung surgery and the cause of prolonged hospital stay frequently associated with major postoperative morbidity and thus responsible for even higher hospital costs. This case-control study was designed to test the sealing efficacy and safety of Enable-Innoseal TP4 in patients undergoing pulmonary resection for lung cancer. MethodsThis was a case-control trial enrolling patients with primary or single site metastatic lung cancer scheduled for elective anatomic or nonanatomic pulmonary resection presenting intraoperative grade 1 or 2 air leak at water submersion test; the study group population was then matched 1:1 according to surgical procedure, male/female ratio, preoperative FEV1, and age. ResultsIn the study population, 21 patients (70.0%) presented intraoperative grade 1 air leak and 9 patients grade 2 (30.0%) air leak; after comparison with the control group, we observed a significant shorter time for chest drain removal in the study population (P = 0.0050), whereas no difference was registered in terms of number of days needing for discharge (P = 0.0762). ConclusionsEnable-Innoseal TP4 was effective in treating limited intraoperative air leaks after pulmonary resection and preventing prolonged postoperative air leaks in patients receiving either anatomic or nonanatomic lung resections. Further randomized double-arm studies are required to confirm the efficacy of Enable-Innoseal TP4 demonstrated by this pilot study.

Postoperative pyothorax a risk factor for acute exacerbation of idiopathic interstitial pneumonia following lung cancer resection.

Acute exacerbation (AE) of idiopathic interstitial pneumonia (IP) is a potentially fatal postoperative complication following lung cancer resection. Postoperative pyothorax (PP) following development of a bronchopleural fistula (BPF) after lung surgery induces continuous inflammation and may affect the occurrence of AE. We investigated the relationship between AE and PP in patients who underwent pulmonary resection for lung cancer. A total of 941 patients who underwent lung resection due to primary lung cancer from 2006 to 2015 at our hospital were investigated. Of the 941 enrolled patients, 137 (14.6%) had idiopathic IP and were predominantly male (p<0.01). Pathological stage Ia and adenocarcinoma were observed at significantly high rates in the non-IP group (p<0.01). Patients with IP showed a tendency for a higher percentage of PP (p=0.054). Of the 137 patients with IP, 17 (12.4%) showed postoperative AE. Furthermore, PP was observed in three cases in the AE(+) group and two in the AE(-) group. PP had a correlation with a significantly higher incidence of AE (p=0.007). PP was found to be a significant risk factor for postoperative AE in lung cancer patients undergoing a pulmonary resection. Since IP itself is likely a risk factor for PP, prevention of BPF is important for patients with IP, as it can lead to PP.

Prediction of Surgical Outcome by Modeling Based on Risk Factors of Morbidity After Pulmonary Resection for Lung Cancer in Older Adults

Surgical treatment for older patients with lung cancer presents more challenges compared with general population. The aim of the study was to predict surgical outcome after pulmonary resection in older patients with lung cancer by developing a clinical model. Clinical records of 525 patients who were older than 70 years of age and who underwent pulmonary resection for lung cancer in a single center were reviewed. Patients were divided into three ordered categories of surgical outcome according to the Clavien-Dindo classification. By using a development cohort of 401 patients, an ordinal logistic regression was performed to develop a prediction model for surgical outcome. The model was internally validated by the bootstrap method and was externally validated by another cohort of 124 patients. Two previous models were tested as benchmarks of our model. The model was developed based on five riskfactors of morbidity: American Society of Anesthesiologists classification (p < 0.001), pulmonary disease (p= 0.001), tumor size (p= 0.011), tumor location (p= 0.015), and surgical approach (p= 0.036). The c-statistic of themodel was 0.75 (95% confidence interval: 0.69 to 0.80),which was similar to the bootstrapping one (0.75; 95% confidence interval: 0.68 to 0.80). The Hosmer-Lemeshow test showed a strong goodness of fit of the model (p= 0.674). In external validation, the performance of our model was superior to that of the two previous models. Our model displayed an acceptable ability to predict surgical outcome in older patients undergoing pulmonary resection for lung cancer. Use of the model can be helpful in decision making about surgical treatment in this special population.

Surgical Treatment of Lung Cancer in Patients with Psychiatric Disorders: A Retrospective Study

Background: The purpose of this retrospective study was to examine the clinical outcomes of patients with concomitant lung cancer and psychiatric disorders who underwent pulmonary resection at our institution and develop a strategy for treating such patients in the future. Methods: We retrospectively reviewed 23 patients with psychiatric disorders who underwent pulmonary resection for lung cancer at our institution between January 1984 and December 2011. Results: The study population comprised 13 men and 10 women with an average age of 67.4 years. The histological types of lung cancer included adenocarcinoma in 14 patients, squamous cell carcinoma in 4, and other types in 5. Fifteen patients were classified as having pathological TNM stage I cancer, four as having stage II, three as having stage III, and one as having stage IV. The coexisting psychiatric disorders were neurosis in eight patients, depression in seven, schizophrenia in five, dementia in two, and oligophrenia in one. Three patients were admitted without a full understanding of the operation. There were no major complications with the exception of delirium, which was seen in eight patients. None of these patients’ coexisting psychiatric disorders worsened. No perioperative death occurred. Conclusions: At our institution, we cooperate closely with psychiatrists to care for surgical patients with psychiatric disorders. There is a possibility that such cooperation will reduce the frequency of previously reported complications.

Surgical outcomes of pulmonary resection for lung cancer after neo-adjuvant treatment

Surgical outcomes of pulmonary resection for lung cancer after neo-adjuvant treatment

A Double-Blind Placebo-Controlled Study of the Effects of Olprinone, a Specific Phosphodiesterase III Inhibitor, for Preventing Postoperative Atrial Fibrillation in Patients Undergoing Pulmonary Resection for Lung Cancer

We previously reported that patients with elevated preoperative B-type natriuretic peptide (BNP) levels have an increased risk for postoperative atrial fibrillation following lung cancer surgery. The present study evaluated whether the specific phosphodiesterase III inhibitor olprinone can reduce the incidence of postoperative atrial fibrillation in patients with elevated BNP levels undergoing pulmonary resection for lung cancer. A prospective randomized study was conducted with 40 patients who had elevated preoperative BNP levels (≥ 30 pg/mL) and underwent scheduled lung cancer surgery. All patients were in sinus rhythm at surgery. Low-dose olprinone or placebo was continuously infused for 24 h and started just before anesthesia induction. The primary end point was the incidence of postoperative atrial fibrillation. The secondary end points were perioperative hemodynamics and levels of BNP, WBC counts, and C-reactive protein. The incidence of postoperative atrial fibrillation was significantly lower in the olprinone group than in the placebo group (10% vs 60%, P < .001). Patients in the olprinone group showed significantly lower BNP, WBC counts, and C-reactive protein levels after surgery. Continuous infusion of olprinone during lung cancer surgery was safe and reduced the incidence of postoperative atrial fibrillation following pulmonary resection in patients with elevated preoperative BNP levels. Japan Primary Registries Network; No.: JPRN-UMIN2404; URL: http://www.umin.ac.jp/ctr/.