Abstract
Of 1, 337 patients with primary lung cancer undergoing surgical resection from August 1984 through December 1999, there were four kinds of perioperative complications for which we had trouble to manage the patients. In this study we reported the clinical outcomes and the methods of management of the patients with preoperative acute inflammatory pulmonary diseases (AINP), preoperative idiopathic interstitial pneumonia (IIP), postoperative empyema (EM) and post-operative interstitial pneumonia (PIP) without preoperative IIP. The number of operative deaths within 30 days was three (0.2%) of all cases.
AINP (n=20) was defined preoperatively as inflammatory pulmonary diseases (CRP≥5) related to extention of the tumors. 8 patients suddenly changed for the worse, 4 of whom (obstructive pneumonia in 2, total atelectasis of one lung in 1 and acute growth of the tumor in 1) required emergent operations. There were no deaths in any of these 4 patients. Of 10 patients with IIP, 3 patients in the early period of this series died of acute exacerbation of IIP. The latest 7 patients had an uneventful postoperative course owing to low-dose O2 administra tion during operation, steroid pulse therapy perioperatively and long-term antibiotics. EM broke out in 15 patients. There were no deaths in 9 patients in the early stage within 30 postoperative days, but 2 of 6 patients in the late stage, all of whom had received induction therapy, died in hospital. PIP shadows on chest X-P appeared in 11 patients, with 5 early patients dying of respiratory failure. Since we recognized that mostly this lethal complication had ocurred in patients with advanced lung cancer on the right side associated with complete dissection of mediastial lymph nodes, an initial vague shadow had started in the lower field on the left side and immediate initiation of steroid pulse therapy had determined the prognosis, the latest consecutive six patients recovered from the grave complication of PIP.
