Background: Interstitial lung disease (ILD) is a group of diffuse lung diseases that mainly involve the interstitial and alveolar cavities and result in loss of alveolar-capillary functional units, leading to restrictive ventilatory dysfunction and diffusion impairment. There was an increased incidence of lung cancer on the basis of ILD, and perioperative risk of patients with lung cancer combined with ILD (LC-ILD) was significantly increased. The aim of this study is to summarize the safety and experience of surgical treatment of LC-ILD.
Methods: A retrospective analysis was performed on 23 patients with LC-ILD who underwent pneumonectomy in Beijing Hospital from January 2012 to December 2019, and their clinical manifestations, image feature, pathology, surgical safety, perioperative complications and treatment experience were summarized.
Results: A total of 23 patients were included in this study, including 20 males (87.0%) with an average age of (69.1±7.8) years, and 19 cases (82.6%) were smokers. Of the ILD types, 14 cases (60.9%) were idiopathic pulmonary fibrosis, 7 cases (30.4%) were idiopathic nonspecific interstitial pneumonia, and 2 (8.7%) were interstitial lung disease associated with connective tissue diseases. The pathology of lung cancer included adenocarcinoma (30.4%, 7/23), small cell carcinoma (30.4%, 7/23), squamous cell carcinoma (26.1%, 6/23), small cell carcinoma mixed with squamous cell carcinoma (4.3%, 1/23) and large cell neuroendocrine carcinoma (8.7%, 2/23). Surgical approaches included video assisted thoracoscopy (69.6%, 16/23) and anterolateral thoracotomy (30.4%, 7/23), with lobectomy (52.2%, 12/23), double lobectomy (4.3%, 1/23), and sublobectomy (39.1%, 9/23). There were 11 cases (47.8%) of postoperative complications, including 8 cases (34.8%) of pulmonary complications, 4 cases (17.4%) of acute exacerbation of ILD (AE-ILD), 6 cases (26.1%) of atrial fibrillation, and 1 case (4.3%) of acute left ventricular dysfunction. The 90-day mortality is 8.7% (2/23) and the cause of death was acute exacerbation of ILD.
Conclusions: Most of LC-ILD were elderly patients with multiple comorbidities and decreased pulmonary function, leading to significantly increased surgical risk. The ILD should be fully evaluated and controlled before surgery, intraoperative trauma should be minimized, and special attention should be paid to pulmonary complications and AE-ILD after surgery. Postoperative AE-ILD has a poor prognosis and glucocorticoids may be effective. Early diagnosis and treatment is the key to treatment of AE-ILD.
【中文题目：肺癌合并间质性肺病的外科治疗】 【中文摘要：背景与目的 间质性肺病（interstitial lung disease, ILD）是一组主要累及肺间质和肺泡腔导致肺泡-毛细血管功能单位丧失的弥漫性肺疾病，常导致限制性通气功能障碍和弥散功能障碍。ILD基础上肺癌发病率增高，肺癌合并间质性肺病（lung cancer combined with ILD, LC-ILD）的手术风险明显增加。本研究旨在探讨LC-ILD外科治疗的安全性，总结围术期诊治经验。方法 回顾性分析2012年1月-2019年12月北京医院胸外科收治的LC-ILD行肺切除术的患者资料，总结其临床表现、影像、病理、手术安全性、围术期并发症和诊治经验。结果 本研究共纳入23例患者，男性20例（87.0%），平均年龄（69.1±7.8）岁，吸烟者19例（82.6%）。ILD类型包括特发性肺纤维化14例（60.9%）、特发性非特异性间质性肺炎7例（30.4%）、结缔组织病相关ILD 2例（8.7%）。肺癌病理包括腺癌7例（30.4%）、小细胞癌7例（30.4%）、鳞癌6例（26.1%）、小细胞癌混合鳞癌1例（4.3%）、大细胞癌2例（8.7%）。手术入路包括经电视胸腔镜16例（69.6%）和前外侧开胸7例（30.4%），切除方式包括肺叶切除13例（56.5%）、双肺叶切除1例（4.3%）和亚肺叶切除9例（39.1%）。术后90 d并发症11例（47.8%），其中肺部并发症8例（34.8%），ILD急性加重（acute exacerbation of ILD, AE-ILD）4例（17.4%），心房纤颤6例（26.1%），急性左心功能不全1例（4.3%）。术后90 d死亡2例（8.7%），死因均为AE-ILD。结论 LC-ILD以合并症多、肺功能差的高龄患者居多，手术风险明显增高。术前应充分控制ILD病情，术中尽量降低手术创伤，术后应特别关注肺部并发症和AE-ILD。AE-ILD预后差，治疗难度大，糖皮质激素有助于改善病情，早诊早治是治疗关键。】 【中文关键词：肺疾病；肺肿瘤；肺切除术；治疗结果】.
Keywords: Lung diseases; Lung neoplasms; Pneumonectomy; Treatment outcome.