Sekihara Keigo, Takei Kensuke, Homma Koshi, Shibata Motohisa, Funai Kazuhito
Division of Surgery First, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo Ward, Hamamatsu 431-3192, Japan.
J Clin Med. 2025 Aug 13;14(16):5724. doi: 10.3390/jcm14165724.
Acute exacerbation of interstitial lung disease (AE-ILD) is a life-threatening complication in lung cancer patients with pre-existing ILD. Anatomical resection is recognized as a significant risk factor for AE-ILD. We investigated the safety and feasibility of wedge resection in lung cancer patients with ILD. This retrospective study analyzed clinical stage IA-IIIA primary lung cancer patients with ILD, as recorded in the Shizuoka Registry across eight institutions from January 2019 to May 2023. Patients were categorized into a wedge resection group (WG) and an anatomical resection group (AG), which included segmentectomy, lobectomy, and bilobectomy. Perioperative outcomes were compared between the groups. The WG comprised 36 patients, while the AG included 81. The WG had significantly older patients (77 vs. 72 years, < 0.01) and smaller tumors (18 vs. 24 mm, < 0.01). Wedge resection was associated with shorter operative time (100 vs. 205 min, < 0.01) and less blood loss (5 vs. 30 mL, = 0.02). The incidence of postoperative complications did not differ significantly ( = 0.84). AE-ILD occurred in three patients (8%) in the WG and four patients (4%) in the AG. Perioperative mortality was 0% in the WG and 2% in the AG; both deaths were due to AE-ILD. Marginal recurrence was observed in four patients (11%) in the WG. Although AE-ILD incidence was higher, no deaths due to IP-AE were observed in the WG. While wedge resection cannot completely prevent postoperative AE-ILD, it may reduce perioperative mortality in lung cancer patients with ILD.
间质性肺疾病急性加重（AE-ILD）是患有基础ILD的肺癌患者的一种危及生命的并发症。解剖性切除被认为是AE-ILD的一个重要危险因素。我们研究了楔形切除在患有ILD的肺癌患者中的安全性和可行性。这项回顾性研究分析了2019年1月至2023年5月静冈登记处记录的八家机构中临床分期为IA-IIIA期的原发性肺癌合并ILD患者。患者被分为楔形切除组（WG）和解剖性切除组（AG），后者包括段切除术、肺叶切除术和双肺叶切除术。比较了两组的围手术期结果。WG组有36例患者，而AG组有81例。WG组患者年龄显著更大（77岁对72岁，<0.01）且肿瘤更小（18mm对24mm，<0.01）。楔形切除与手术时间更短（100分钟对205分钟，<0.01）和失血量更少（5mL对30mL，=0.02）相关。术后并发症发生率无显著差异（=0.84）。WG组有3例患者（8%）发生AE-ILD，AG组有4例患者（4%）发生。WG组围手术期死亡率为0%，AG组为2%；两例死亡均因AE-ILD。WG组有4例患者（11%）观察到边缘复发。虽然AE-ILD发生率更高，但WG组未观察到因IP-AE导致的死亡。虽然楔形切除不能完全预防术后AE-ILD，但它可能降低患有ILD的肺癌患者的围手术期死亡率。
