Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata-shi, Niigata, 951-8510, Japan.
Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
BMC Pulm Med. 2018 Aug 10;18(1):134. doi: 10.1186/s12890-018-0703-8.
Patients with idiopathic pulmonary fibrosis (IPF) have a high risk of developing lung cancer, but few studies have investigated the long-term outcomes of repeated surgery in such patients. The purpose of this study was to evaluate the surgical outcomes of repeated lung cancer surgery in patients with IPF.
From January 2001 to December 2015, 108 lung cancer patients with IPF underwent pulmonary resection at two institutions; 13 of these patients underwent repeated surgery for lung cancer, and their data were reviewed.
The initial procedures of the 13 patients were lobectomy in 8, segmentectomy in 2, and wedge resection in 3. The subsequent procedures were wedge resection in 10 and segmentectomy in 3. The clinical stage of the second tumor was stage IA in 12 and stage IB in 1. Postoperatively, 3 patients (23.1%) developed acute exacerbation (AE) of IPF and died. The rate of decrease in percent vital capacity was significantly higher in patients with AE than in those without AE (p = 0.011). The 3-year overall survival rate was 34.6%. The causes of death were cancer-related in 7, AE of IPF in 3, and metachronous lung cancer in 1.
Despite limited resection, a high incidence of AE was identified. The early and long-term outcomes of repeated surgery in lung cancer patients with IPF were poor because of the high risk of AE of IPF and lung cancer recurrence. Long-term intensive surveillance will be required to determine whether surgical intervention is justified in patients with multiple primary lung cancers and IPF.
特发性肺纤维化（IPF）患者发生肺癌的风险较高，但很少有研究调查此类患者重复手术的长期结果。本研究旨在评估 IPF 患者重复肺癌手术后的手术结果。
2001 年 1 月至 2015 年 12 月，有两家机构的 108 例 IPF 肺癌患者接受了肺切除术；其中 13 例患者因肺癌接受了重复手术，并对其数据进行了回顾。
13 例患者的初始手术为 8 例肺叶切除术、2 例节段切除术和 3 例楔形切除术。随后的手术为 10 例楔形切除术和 3 例节段切除术。第二个肿瘤的临床分期为 IA 期 12 例和 IB 期 1 例。术后，3 例（23.1%）患者发生特发性肺纤维化急性加重（AE）并死亡。AE 患者的肺活量百分比下降率明显高于无 AE 患者（p=0.011）。3 年总生存率为 34.6%。死亡原因分别为癌症相关 7 例、AE 3 例和异时性肺癌 1 例。
尽管进行了有限的切除，但仍存在高发病率的 AE。特发性肺纤维化合并肺癌患者重复手术的早期和长期结果较差，因为特发性肺纤维化和肺癌复发的风险较高。需要长期的强化监测，以确定在患有多发性原发性肺癌和特发性肺纤维化的患者中是否需要手术干预。
