[Prophylactic administration of steroid for interstitial pneumonia after pulmonary resection for lung cancer]

The aim of the present study is to investigate the perioperative management of acute exacerbation of idiopathic interstitial pneumonia (IIP) after pulmonary resection for lung cancer.

At first, we reviewed 5 Japanese literatures published from 1992 through 1998. Within 30 days after operation, acute exacerbation of IIP occurred in 24.0% of those cases. Preoperative profiles (gender, age, smoking status, respiratory function, pathologic stage) of the exacerbated cases did not differ from those of non-exacerbated cases. The mean intraoperative PO2 of the exacerbated cases was significantly higher than that of non-exacerbated cases (224 Torr versus 120 Torr, p=0.005). Despite high-dose administration of steroids, mortality rate after acute exacerbation of IIP was 91.7%. Second, in order to investigate both the benefits and adverse effects of prophylactic administration of methylprednisolone for interstitial pneumonia (IP) after pulmonary resection, we reviewed 41 patients with primary lung cancer who underwent complete resection. Of these, 24 patients who had 2 or more risk factors for postoperative IP were given 125 mg of methylprednisolone intravenously just before the thoracotomy. The risk factors included male gender, Brinkmann index > or = 600, and the presence of interstitial changes on chest computed tomography (CT). Otherwise, all patients were followed under our postoperative management without oxygen administration. The serum CRP on the 3rd postoperative day was significantly lower in the steroid group than in control (8.5 mg/dl versus 13.3 mg/dl, p=0.011) while it was not different between those 2 groups on the 7th postoperative day. Both the mean days of postoperative hospital stay and the disease-free survival were not different between the 2 groups.

Prophylactic administration of methylprednisolone for IP might be effective without significantly adverse effects.