Elsevier

The Annals of Thoracic Surgery

Volume 76, Issue 5, November 2003, Pages 1674-1678
The Annals of Thoracic Surgery

Original article: general thoracic
Operation for lung cancer in patients with idiopathic pulmonary fibrosis: surgical contraindication?

https://doi.org/10.1016/S0003-4975(03)00966-4Get rights and content

Abstract

Background

Patients with idiopathic pulmonary fibrosis have an increased incidence of lung cancer. The purpose of this study was to determine the outcome of surgical treatment of lung cancer with idiopathic pulmonary fibrosis.

Methods

From January 1992 through December 2001, 64 patients who had simultaneous lung cancer and idiopathic pulmonary fibrosis were treated. Twenty-one (33%) of them underwent surgical resection of lung cancer, and their data were reviewed.

Results

There were 56 men and 8 women with an average age of 69 years (range, 43 to 85 years). In the surgical group, there were no early postoperative deaths, and nonfatal complications occurred in 2 patients (10%). Among the 14 patients with stage I cancer, a second primary lung cancer developed in 5 (36%). The causes of death in the surgical group were cancer related in 7 patients, exacerbation of idiopathic pulmonary fibrosis in 7, and other in 2. Five of the 7 patients who died of a cancer-related cause had development of a second primary lung cancer. The actuarial 2-year survival rate of the surgical group was 52% overall, 58% for patients with N0 or N1 disease and 25% for those with N2 disease (p = 0.05).

Conclusions

The long-term results in one surgical group were poor partly because of the high incidence of a second primary lung cancer and partly because of the poor natural history of idiopathic pulmonary fibrosis. These patients require intensive surveillance even after curative resection of lung cancer.

Section snippets

Material and methods

From January 1992 through December 2001, 64 patients with simultaneous lung cancer and IPF were seen at the Respiratory Diseases Center, Kyoto-Katsura Hospital, and their records were analyzed in the present study. The three entry criteria were as follows: lung cancer was discovered during follow-up for a past case of IPF or was discovered simultaneously with IPF; the diagnosis of lung cancer was confirmed either histologically or cytologically; and the diagnosis of IPF was confirmed as will be

Results

The group of 64 patients comprised 56 men and 8 women with an average age of 68.8 years (range, 43 to 85 years).

Comment

This is one of the first reports compiling the surgical results for patients with concomitant UIP or IPF and lung cancer. Our study showed a poor prognosis for these patients even after complete resection of the lung cancer, with 2- and 5-year survival rates of 52% and 0%, respectively. The question of whether to operate is under debate, as patients with IPF are known to have a poor prognosis, and those with unresected lung cancer have a terrible course. We should consider not only whether to

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