[Perioperative Management of Patients with Pulmonary Comorbidities Undergoing Lung Resection]

Chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) are 2 major pulmonary comorbidities of primary lung cancer patients. The COPD patients are at risk for respiratory failure after a major lung resection when lung resection exceeds the patient's pulmonary reserve. It is important to assess a postoperative risk based on the patient's cardiopulmonary function. Cardiac risks are initially evaluated for all the candidates for lung resection, then, ppoFEV1% and ppoDLco% are calculated. If these 2 parameters are not satisfactory, cardiopulmonary exercise test is required to assess the risk. Adequate treatment for COPD should be given to the patients through the perioperative period. ILD is another major comorbidity of lung cancer patients, and its acute exacerbation (AE) is the leading cause of postoperative death. The Japanese Association of Chest Surgery proposed a risk scoring system for predicting postoperative AE. Currently there is no reliable management to prevent or ameliorate postoperative AE. Methylprednisolone pulse therapy is empirically performed as a treatment for AE with controversial evaluation. Pirfenidone and some other drugs are expected to reduce the occurrence of postoperative AE, however, further studies will be needed to confirm the efficacy and the safety.