Interstitial pneumonia after surgery for esophageal cancer-related disease

Abstract

Interstitial pneumonia is a potentially fatal complication after surgery. Between April 2003 and March 2007, 182 patients underwent thoracotomy for esophageal cancer-related diseases in our hospital. Of these, 7 (4%) developed interstitial pneumonia. In this study, we studied the backgrounds, treatments and prognoses of these 7 patients. We found that all were men (mean age : 67 years) with history of smoking. Five had undergone esophagectomy for esophageal cancer, one had gastric tube cancer and received a distal gastrectomy using the left thoracoabdominal approach, and one had a gastric tube-lung fistula and underwent bypass surgery using the right colon. They all received steroid-pulse therapy, after which the steroid dose was gradually reduced. In four cases, however, pneumonia shadows redeveloped, and three (43%) died in hospital of interstitial pneumonia. In two of the patients who died, the dose of steroid was re-increased again after reduction, and two had received chemoradiotherapy. All three suffered from malmutrition and MRSA infection in their sputum. It has been suggested that cases with malnutrition or MRSA infection, and cases treated with pre-operative chemoradiotherapy or repeated steroid therapy are the coses leading to poor prognoses when interstitial pneumonia develops after sugery for esophageal cancer-related disease.