Interstitial pneumonia and advanced age negatively influence postoperative pulmonary function

Changes in postoperative pulmonary function vary among patients after lobectomy. We aimed to define preoperative factors that negatively influence postoperative % vital capacity (%VC) in patients treated by lobectomy.

We included 276 patients who had been treated by lobectomy at our institution between 2007 and 2018 and their preoperative and postoperative pulmonary function data were complete. We assigned them to groups based on postoperative pulmonary function defined as better (good) or worse (poor) than predicted %VC, then compared clinicopathological findings between them. Poor postoperative pulmonary function was also assessed using logistic regression analysis.

Interstitial pneumonia (IP) was diagnosed in 37 (13.4%) patients. The preoperative and postoperative %VC values were, respectively, 101.1% (interquartile range, 90.5-110%) and 87.6% (interquartile range, 73.8-99.1%). Logistic regression analysis revealed that IP, advanced age (≥75 years), and induction therapy were independent risk factors for reduced postoperative pulmonary function [odds ratios 3.01 (1.41-6.41), 2.49 (1.35-4.60), and 9.03 (2.43-33.5), P = 0.0044, 0.0035, and 0.001, respectively]. Postoperative %VC worsened with increasing IP severity and advanced age. Six (75%) of 8 patients aged ≥80 years with usual IP or suspected usual IP on preoperative computed tomography images had poor postoperative %VC.

Surgical indications for lobectomy based on predicted postoperative %VC require careful consideration for elderly patients with IP, particularly those aged ≥80 years.