Advantages and disadvantages of corticosteroid use for acute exacerbation of interstitial pneumonia after pulmonary rese
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ORIGINAL ARTICLE
Advantages and disadvantages of corticosteroid use for acute exacerbation of interstitial pneumonia after pulmonary resection Mariko Fukui1 · Kazuya Takamochi1 · Kazuhiro Suzuki2 · Katsutoshi Ando3 · Takeshi Matsunaga1 · Aritoshi Hattori1 · Shiaki Oh1 · Kenji Suzuki1 Received: 15 July 2020 / Accepted: 4 September 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objectives Acute exacerbation of interstitial pneumonia (AE-IP) is the top cause of 30-day mortality in surgery for lung cancer patients. The general treatment for AE-IP is corticosteroid; however, there are some disadvantages of corticosteroid use after surgery. This study was conducted to report the clinical course of AE-IP after surgery and evaluate the effect of corticosteroid use. Methods This retrospective study was performed on 337 patients with interstitial pneumonia who underwent surgical resection for lung cancer at our institute between 2009 and 2018. AE-IP were observed in 14 patients (4.2%) and their management and clinical outcome were investigated. Results All patients received methylprednisolone pulse therapy. Six patients (42.9%) became convalescent after pulse therapy and eight (57.1%) died within 90 days after surgery due to lack of therapeutic efficacy. Oxygenation and ground-glass opacities of the survivors improved within 3 days after starting pulse therapy. Patients who responded to the first pulse also responded to the second pulse. Four patients developed complications including two with bronchopulmonary fistulas that may be related to steroid treatment. Even if the corticosteroid was effective, all AE-IP patients died within 1 year after surgery. Conclusions Corticosteroid therapy is effective for AE-IP after surgery; however, it may lead to severe complications after surgery. Keywords Idiopathic interstitial pneumonia · Pulmonary fibrosis · Lung cancer · Surgery · Acute exacerbation
Introduction Acute exacerbation of interstitial pneumonia (AE-IP) is the main cause of 30-day mortality in surgery for lung cancer patients [1–3]. A multi-institutional retrospective study conducted by the Japanese Association for Chest Surgery reported that AE-IP occurred in 164 (9.3%) patients of 1763 postoperative patients with IP, and with a mortality rate of 43.9% [4]. Despite the high morbidity and mortality * Mariko Fukui [email protected] 1
Departments of General Thoracic Surgery, Juntendo University School of Medicine, 1‑3, Hondo 3‑chome, Bunkyo‑ku, Tokyo 113‑8431, Japan
2
Departments of Radiology, Juntendo University School of Medicine, Tokyo, Japan
3
Department of Respiratory Medicine, Juntendo University School of Medicine, Tokyo, Japan
associated with AE-IP, there are limited data to guide management even in cases other than surgery. Guidelines on the management of IPF make a weak recommendation for the use of corticosteroids including pulse [5–7]. There have so far been no reports form controlled comparative studies allowing their efficacy to be assessed, but guidelines gave we
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