Risk Factors Of Pulmonary Complications After Thoracic Surgery In Lung Cancer Patients With Idiopathic Pulmonary Fibrosis

Purpose Idiopathic pulmonary fibrosis is a relatively common clinical interstitial lung disease,which is mainly manifested as progressive development of lung fibrosis.In clinical practice,lung cancer with idiopathic pulmonary fibrosis is not uncommon,but due to the combination of idiopathic pulmonary fibrosis,such patients with lung surgery may face higher perioperative incidence of pulmonary complications and mortality.At present,the study of perioperative related to these patients is mainly concentrated in foreign countries,there are few reports in domestic.The general clinical features and perioperative pulmonary complications is not clear.Therefore,in order to further understand the clinical features of patients treated with surgery for IPF-LC,explore the impact of IPF on the incidence and mortality of perioperative complications in patients with lung cancer and the possible risk factors for perioperative pulmonary complications,better guide the perioperative management,ensure a successful operation and improve patient's survival,we carried out the study.Methods This study selected patients who received thoracic surgery due to lung cancer from January 2012 to June 2016 in Tianjin Chest Hospital with the following admission and exclusion criteria: postoperative pathology confirmed lung cancer;complete preoperative,intraoperative and postoperative clinical data.Exclusion criteria: pneumonectomy;preoperative radiotherapy,chemotherapy;known causes may lead to pulmonary interstitial disease in patients.The final 673 patients were included in the study,of which 53 patients had idiopathic pulmonary fibrosis.First,673 cases of lung cancer were divided into two groups according to whether or not IPF was combined to compare and analyses the difference of clinical features.The IPF-LC patients were further divided into pulmonary complication group and non-pulmonary complication group.The factors influencing the postoperative pulmonary complications were analyzed by multivariate analysis.The receiver operating characteristic curve(ROC)was analyzed and the cutoff value was determined.The same approach was used to analyze the risk factors for postoperative pulmonary infection.Results 1.The proportion of male patients in IPF-LC patients was significantly higher than that of non-IPF-LC patients.Adenocarcinoma was the main pathological type of IPF-LC patients,followed by squamous cell carcinoma.Compared with non-IPF-LC patients,the levels of FVC%Pre and DLco%Pre in the lung function of IPF-LC patients were significantly decreased(P <0.05).The incidence and mortality of pulmonary complications in patients with IPF-LC were significantly higher than those in non-IPF-LC patients(39.6% vs 10%,3.8% vs 0.2%,P <0.05).The incidence of perioperative pulmonary complications in patients with IPF-LC was 39.6%.Among them,11 cases(20.8%)were pulmonary infection,10 cases(18.9%)of atelectasis,continued lung leakage in 5 cases(9.4 %),respiratory failure in 4 cases(7.5%),acute exacerbation in 2 cases(1.8%).Two patients(3.8%)died within 30 days of perioperative surgery and 3 patients(5.7%)died within 90 days.Decreased FVC%Pre and DLco%Pre were independent risk factors for pulmonary complications after lung cancer with idiopathic pulmonary fibrosis.The area under the ROC curve of FVC%Pre and DLco%Pre were 0.810 and 0.774,the cut-off value were 79.8% and 72.5%.FEV1%Pre,FVC% Pre and DLCO% Pre were related to postoperative pulmonary infection,but no independent risk factors were found in smoking status,smoking index and lung function index.Conclusion IPF-LC patients were predominantly smokers,and adenocarcinomas were the main pathological types of squamous cell carcinoma.Pulmonary function was mainly reduced by FVC%Pre and DLco%Pre.The decrease of FVC%Pre and DLco%Pre was an independent risk factor for perioperative pulmonary complications.When FVC%Pre<79.8% and DLco%Pre <72.5%,the postoperative pulmonary complications were predicted with the accuracy of 81.0% and 77.4%,respectively.3.The risk factors for postoperative AEIPF are not clear,and the decline in smoking and lung function may suggest a postoperative pulmonary infection,which remains to be further studied.