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Eur J Cardiothorac Surg 2006;30:657-662
© 2006 Elsevier Science NL

Acute interstitial pneumonia following surgery for primary lung cancer

^a Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
^b Division of Pathology, Nagasaki University Hospital, Nagasaki, Japan

Received 21 April 2006; received in revised form 4 June 2006; accepted 26 June 2006.

^_* Corresponding author. Address: Department of Chest Surgery, Oita Prefectural Hospital, 476 Ohaza-Bunyou, Oita 870-8511, Japan. Tel.: +81 97 546 7111; fax: +81 97 546 0725. (Email: mmuraoka{at}oitakenbyo.jp).

Objective: Although acute interstitial pneumonia is a life-threatening complication following surgery for lung cancer, the cause and risk factors for acute interstitial pneumonia remain unknown. We conducted this study to determine the characteristics of acute interstitial pneumonia after pulmonary resection and to identify the risk factors for this disease. Methods: We experienced 16 (2.0%) cases of acute interstitial pneumonia among 822 patients who underwent pulmonary resection for primary lung cancer over a period of 12 years. We performed a retrospective analysis of these patients, comprising the patients’ background, the operative procedure, the radiographic characteristics and the prognosis. Results: In all patients, the shadow appeared within 1 week after the operation. Twelve patients required mechanical ventilatory support due to the development of respiratory failure. The site of the tumor (right side), preoperative radiation or chemotherapy, pneumonectomy, blood transfusion, and intraoperative complication were independent risk factors for the incidence of acute interstitial pneumonia (P = 0.001, 0.0484, 0.0012, 0.0002, 0.0003, respectively) in the multivariate analysis. Nine of the 16 patients died due to respiratory failure, resulting in a mortality rate of 56.3%. The maximum amount of lactate dehydrogenase (LDH) in the operative death patients was significantly higher than that in the survivors (472 ± 138 IU/l vs 257 ± 79 IU/l, respectively, P = 0.0031). Conclusions: We concluded that in order to reduce the incidence of acute interstitial pneumonia, it is necessary to perform careful postoperative management for patients who are male, have right lung disease, have undergone preoperative chemo or radiation therapy, or have undergone pneumonectomy.

Key Words: Acute respiratory distress syndrome (ARDS) • Lung cancer surgery • Outcomes (operative mortality)