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Late sequelae of lobectomy for primary lung cancer: fibrobullous changes in ipsilateral residual lobes

Department of Surgery, National Hospital Organization Kinki-chuo Chest Medical Center, 1180 Nagasonechou, Sakai, Osaka 591-8555, Japan

Received 20 June 2007; received in revised form 14 August 2007; accepted 3 September 2007.

^_* Corresponding author. Tel.: +81 722 52 3021; fax: +81 722 51 1372. (Email: h-tanaka{at}kch.hosp.go.jp).

Background: Late complications after lobectomy for primary lung cancer are rare. Progressive fibrobullous changes in the ipsilateral residual lobes were observed in some of the long-surviving patients after lobectomy for lung cancer. We report clinical details of this late complication. Methods: Between 1975 and 1997, we selected 39 patients (35 males and 4 females) from a total of 1321 patients who underwent lobectomy for primary lung cancer. Results: The incidence rate of this complication was 3%; this increased to 5.6% in patients who had survived for 5 years or more. A chest roentgenogram revealed fibrobullous changes on an average of 2.5 years (range 3 months–6 years) after lobectomy; these changes progressed throughout the ipsilateral lobes over several years. Ten patients (26%) required continuous oxygen therapy. The fibrobullous lungs of 21 (54%) patients were infected with nontuberculous mycobacterium, aspergillus, methicillin-resistant Staphylococcus aureus, and unidentified bacteria in 5, 4, 1, and 11 patients, respectively. Twenty-four patients died of the following causes: cancer (8, 33%), respiratory failure and chronic infections related to this complication (10, 42%), and other diseases (6, 25%). Three patients underwent successful surgical intervention for treating chronic infection of the destroyed lungs (omentopexy 1, completion pneumonectomy 2). Conclusions: Fibrobullous lung should be recognized as an important late complication that develops in lung cancer patients after lobectomy.

Key Words: Fibrobullous lung • Late complication • Lobectomy • Lung cancer