Predicting Severe Postoperative Complication in Patients With Lung Cancer and Interstitial Pneumonia

Interstitial pneumonia is linked to lung cancer, and treatment can cause acute exacerbation. We aimed to identify predictors of severe postoperative complications in patients with lung cancer and interstitial pneumonia.

Between April 2007 and April 2017, 199 patients were diagnosed with primary lung cancer and interstitial pneumonia using high-resolution computed tomography. Multivariable logistic regression analyses were performed to identify independent predictors of severe complications (Clavien-Dindo grade IIIa or higher).

Multivariable analyses revealed that severe complications were independently predicted by the percent diffusing capacity of the lungs for carbon monoxide (%Dlco [odds ratio 0.88; 95% confidence interval, 0.82 to 0.95; P < .001]) and surgical procedures (lobectomy, odds ratio 4.49; 95% confidence interval, 1.86 to 23.32; P = .045). Severe complications occurred in 39.2% of patients with low %Dlco (less than 40%) and in 4.2% of patients with high %Dlco (greater than 40%). The rates of severe complications were 11.5% for patients who underwent lobectomy and 9.7% for patients who underwent sublobar resection. For patients with low %Dlco, the rates of severe complications were 85.7% for those undergoing lobectomy and 23.8% for those undergoing sublobar resection (P = .009). Overall survival (OS) was significantly different between patients with low %Dlco (5-year OS 33.5%) and patients with high %Dlco (5-year OS 65.3%; P = .001). Among patients with low %Dlco, there was a significant difference in OS between patients who underwent lobectomy (5-year OS 0%) and those who underwent sublobar resection (5-year OS 49.6%; P = .029).

Severe postoperative complications were predicted by %Dlco and surgery type. Sublobar resection might be a better option for patients with low %Dlco values (less than 40%).