PURPOSE: It is well known that idiopathic pulmonary fibrosis (IPF) is associated with an increased lung cancer risk. However, IPF poses an obstacle to surgical treatment, due to the impaired pulmonary function and high postoperative complication rate. Limited resection has often been selected to avoid complications. In this study, we retrospectively reviewed the non-small cell lung cancer (NSCLC) patients with underlying IPF who underwent surgical treatment, and examined the effect of the difference in surgical procedures on outcomes.
METHODS: IPF was diagnosed preoperatively by physical examination and abnormalities compatible with bilateral lung fibrosis on computed tomography. In some cases, IPF was diagnosed by histopathology in the resected lung specimen. Patients with incomplete resection and histopathological lymph node metastasis were excluded from this study. Between 2001 and 2005, 16 patients underwent lobectomy (Lobectomy Group) and 20 patients underwent limited resection (Limit Group), such as wedge resection (n = 18) and segmentectomy (n = 2), at the three institutions. The surgical procedures were decided depending on the surgeons' or institution's policies.
RESULTS: Both groups were matched for age, sex, preoperative pulmonary function, and characteristics of the NSCLC. In both groups, most of the cases was pathological stage I disease (I/II/III: 14/0/2, 19/0/1, respectively). There were no significant differences in the incidence of postoperative complications, acute exacerbation of IPF or respiratory failure. The 3-year and 5-year overall survivals were 60.6%, 53.8% (Lobectomy Group) and 51.7%, 32.3% (Limit Group), respectively (P = 0.03). In the Limit Group, 11 of the 20 patients developed intrathoracic recurrence, while 4 of the 16 patients developed in the Lobectomy Group. The 3-year and 5-year disease-free survivals were 54.5%, 54.5% (Lobectomy Group) and 36.1%, 15.0% (Limit Group), respectively (P = 0.005).
CONCLUSIONS: Limited resection for NSCLC patients with IPF was associated with a higher incidence of intrathoracic recurrence as compared to lobectomy, despite the similar risk for postoperative complications.
CLINICAL IMPLICATIONS: Lobectomy may be performed even for NSCLC patients with IPF if the patient has an adequate pulmonary function.
DISCLOSURE: The following authors have nothing to disclose: Terumoto Koike, Masanori Tsuchida, Takehisa Hashimoto, Hirohiko Shinohara, Toru Shirato, Teruaki Koike, Yasushi Yamato, Katsuo Yoshiya, Takehiro Watanabe
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