Prediction of acute pulmonary complications after resection of lung cancer in patients with preexisting interstitial lung disease

Abstract

Introduction: Interstitial lung disease (ILD) is associated with a high morbidity from acute pulmonary complications, such as acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), after pulmonary resection. This study attempts to uncover the risk factors for postoperative ALI/ARDS in lung cancer patients with ILD.

Materials and methods: We retrospectively reviewed 100 patients with ILD who underwent curative lung resection for lung cancer, from January 2000 to December 2008.

Results: Of the 100 patients, 91 were male, and 9 were female. The median age was 66 years. Fifty-eight patients underwent a preoperative carbon monoxide diffusing capacity test (DLCo). Twelve pneumonectomies and 88 lobectomies were performed. Acute pulmonary complications were observed in 28 patients (13 with ALI and 15 with ARDS). Operative mortality was 14%. Cause of death was due to respiratory failure from ALI/ARDS in all patients, except in one patient who died due to complications of acute renal failure. For all 100 patients, univariate analysis revealed that preexisting comorbidities, such as ischemic heart disease, renal failure, COPD, and neoadjuvant treatment for lung cancer, were risk factors for the development of postoperative ALI/ARDS. For the 58 patients who underwent preoperative DLCo testing, significant univariate risk factors included preexisting comorbidities and decreased DLCo. Multivariate analysis did not show any significant risk factors for ALI/ARDS.

Conclusions: Preexisting comorbidities and decreased preoperative DLCo were the most significant risk factors for the development of acute pulmonary complications after pulmonary resection in patients with lung cancer and ILD.