Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Interstitial Pneumonia and Lung Cancer Surgery

간질성 폐렴과 폐암수술

  • Sa Young-Jo (Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Wang Young-Pil (Department of Thoracic and Cardiovascular Surgery, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Park Jae-Kil (Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 사영조 (가톨릭대학교 의과대학 성모병원 흉부외과) ;
  • 왕영필 (가톨릭대학교 의과대학 강남성모병원 흉부외과) ;
  • 박재길 (가톨릭대학교 의과대학 성모병원 흉부외과)
  • Published : 2006.04.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Interstitial pneumonia is associated with an increased risk of lung cancer but the outcome of surgical resection in this setting is unknown. The purpose of this study was to determine the relationship between pre-operative interstitial pneumonia (IP) and post-operative respiratory failure. Material and Method: A retrospective review of 672 patients with lung cancer who underwent curative pulmonary resection at the Hospital of Catholic University Medical College between 1997 and 2005 was undertaken. The patients were divided into two groups according to preexisting interstitial pneumonia and not by the pre-operative chest HRCT or findings of pathologic papers. The pre-operative data and cancer-related findings were analyzed between the IP group and non-IP group, and between the respiratory failure group and non-failure group in IP patients. Result: Twenty-eight patients (4.2%) of the developed post-operative respiratory failure and this proved to be fatal in 21 of these patients. We could find preoperative interstitial pathology in 53 patients (7.9%) among the 672 patients. The incidences of respiratory failure were 11.3% (6/53 cases) and 3.6% (22/619 cases) in IP group and non-IP group respectively, Conclusion: Interstitial pneumonia was considered one of the risk factors for developing postoperative acute respiratory failure in patients with lung cancer.

배경: 간질성 폐렴(IP)은 폐암의 발생과 깊은 관련이 있으나 수술 후 경과에 미치는 영향은 아직 밝혀진 바 없다. 본 연구의 목적은 술전 간질성 폐렴과 수술 후 급성 호흡부전의 발생과의 관련성을 알아보기 위한 것이다. 대상 및 방법: 1997년 1월부터 2005년 3월까지 가톨릭대학교 의과대학 부속병원에서 근치적 수술을 시행받은 원발성 폐암환자 672예를 대상으로 후향적인 검토를 시행하였다. 수술 전 흉부 HRCT소견이나 수술 표본의 병리조직 판독서에서 간질성 폐렴이 확인된 환자들을 간질성 폐렴(IP)군으로 구분하여, 비합병(non-IP)군과의 사이에 수술 전 검사치와 암 관련 사항들을 비교 분석하였다. 또한 IP군에서는 급성 호흡부전의 발생군과 비발생군 사이에서 급성 호흡부전의 발생에 영향을 줄 수 있는 상이점들을 분석하였다. 결과: 근치적 수술을 시행 받은 672예 중 28예(4.2%)에서 수술 후 급성 호흡부전증이 합병되었으며, 672예 중 수술 전에 IP의 동반이 확인되었던 증례는 53예(7.9%)였다. IP 동반례에서는 6예(11.3%)에서 수술 후 급성 호흡부전증이 합병되었으며, IP가 없었던 619예에서는 22예(3.6%)에서 합병되었다. 급성 호흡부전증의 합병환자 28예 중 21예에서 사망하여 사망률은 75%였다. 결론: 간질성 폐렴은 폐암 수술 후 급성 호흡부전의 발생과 관련이 있다고 생각되었다.

Keywords

References

  1. Hudson LD, Milberg JA, Anardi D, et al. Clinical risks for development of the acute respiratory distress syndrome. Am J Respir Crit Care Med 1995;151:293-301 https://doi.org/10.1164/ajrccm.151.2.7842182
  2. Raghu G, Nyberg F, Morgan G. The epidemiology of the interstitial lung disease and its association with lung cancer. Br J Cancer 2004;91(Suppl 2):S3-10
  3. Park J, Kim DS, Shim TS, et al. Lung cancer in patients with idiopathic pulmonary fibrosis. Eur Respir J 2001;17: 1216-9 https://doi.org/10.1183/09031936.01.99055301
  4. Mizushima Y, Kobayashi M. Clinical characteristics of synchronous multiple lung cancer associated with idiopathic pulmonary fibrosis. Chest 1995;108:1272-7 https://doi.org/10.1378/chest.108.5.1272
  5. Matsushita H, Tanaka S, Saiki Y, et al. Lung cancer associated with usual interstitial pneumonia. Pathol Int 1995;45: 925-32 https://doi.org/10.1111/j.1440-1827.1995.tb03417.x
  6. Kumar K, Goldstraw P, Yamada K, et al. Pulmonary fibrosis and lung cancer: risk and benefit analysis of pulmonary resection. J Thorac Cardiovasc Surg 2003;125:1321-7 https://doi.org/10.1016/S0022-5223(03)00028-X
  7. Kawasaki H, Nagai K, Yoshida J, Nishimura M, Nishiwaki Y. Postoperative morbidity, mortality, and survival in lung cancer associated with idiopathic pulmonary fibrosis. J Surg Oncol 2002;81:33-7 https://doi.org/10.1002/jso.10145
  8. Tanita T, Chida M, Hoshikawa Y, et al. Experience with fatal interstitial pneumonia after operation for lung cancer. J Cardiovasc Surg (Torino) 2001;42:125-9
  9. Fujimoto T, Okazaki T, Matsukura T, et al. Operation for lung cancer in patients with idiopathic pulmonary fibrosis; surgical contraindication? Ann Thorac Surg 2003;76:1674-9 https://doi.org/10.1016/S0003-4975(03)00966-4
  10. Imakiire T, Koike T, Watanabe T, et al. Lung cancer combined with idiopathic interstitial pneumonias. Jpn J Thorac Cardiovasc Surg 2005;58:4-8
  11. Bernard GR, Artigas A, Brigham KL, et al. The American- European Consensus Conference on ARDS. Definitions, mechanisms relevant out-comes, and clinical trial coordination. Am J Respir Crit Care Med 1994;149(3 Pt 1):818-24 https://doi.org/10.1164/ajrccm.149.3.7509706
  12. Watanabe A, Koyanaki T, Osawa H, et al. Lung cancer in patients with idiopathic interstitial pneumonia. Jpn J Thorac Cardiovasc Surg 2005;58:9-14
  13. American Thoracic Society, European Respiratory Society: American Thoracic Society/European Respiratory Society international multidisplinary consensus classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 2002;165:277-304 https://doi.org/10.1164/ajrccm.165.2.ats01
  14. Chida M, Takahashi H, Yamanaka H, et al. Analysis of acute exacerbation from focal usual interstitial pneumonia following to lung cancer resection. Jpn J Thorac Cardiovasc Surg 2005;58:22-5
  15. Onishi H, Yokoyama A, Kondo K, et al. Comparative study of KL-6, surfactant protein-A, surfactant protein-D, and monocyte chemoattractant protein-1 as serum markers for interstitial lung disease. Am J Respir Crit Care Med 2002; 165:378-81 https://doi.org/10.1164/ajrccm.165.3.2107134
  16. Yokoyama A, Kohno N, Hamada H, et al. Circulating KL-6 predicts the outcome of rapidly progressive idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 1998;158: 1680-4 https://doi.org/10.1164/ajrccm.158.5.9803115
  17. Yasui M, Waseda Y, Ichikawa Y, Murakami H. Infectious lung disease and SP-A, SP-D, KL-6. Jpn J Respir Molecu Med 2005;9:32-5
  18. Takaoka K, Kimura B, Akikawa A, et al. Surgically resected lung cancer in patients complicated with diffuse interstitial pulmonary shadow. Jpn J Thorac Cardiovasc Surg 2005;58: 31-5
  19. Otani Y, Shimizu K, Nakano O, et al. Perioperative management for lung cancer with interstitial pneumonia. Jpn J Thorac Cardiovasc Surg 2005;58:46-51
  20. Knight H, Porn RB. Diffuse lung disease; Pathogenesis: variations in response to injury. In: Shields TW, Locicero J III, Ponn RB, Rusch VW. General thoracic surgery. 6th ed. Philadelphia: Lippincott Williams & Wilkins. 2005;1342-73