Preexisting pulmonary fibrosis linked to negative outcomes after Lung resection

A new study found that the short and long-term outcomes in patients with pre-existing pulmonary fibrosis have worse outcomes post-lung resection; hence, segmental resection should be considered to reduce peri-operative risk in these patients.

The study results were published in the journal Respiratory Medicine.  

Pulmonary fibrosis is one of the risk factors for the development of lung cancer. Due to the low incidence of the pathology, thoracic surgery risk scoring systems do not adequately represent it. Hence researchers conducted a study to assess the short and long-term outcomes after lung resection for primary lung cancer in patients with pre-existing pulmonary fibrosis.

The study was carried out between 2012 and 2018 in two UK centers by including 5029 consecutive patients undergoing lung resection for primary lung cancer. Primary outcomes were 90-day & 1-year mortality, postoperative complications, and overall survival. Univariable analyses were used to compare outcomes between patients with and without pre-existing pulmonary fibrosis. 

Results: 

• Pre-existing pulmonary fibrosis was seen in 0.7% (n = 33) of patients (idiopathic pulmonary fibrosis 48.5%, non-specific interstitial pneumonia 6.1%, unknown 45.5%). 
• In patients with fibrosis, the overall 90-day and 1-year mortality were all significantly higher (90-day: 18.2% vs 3.6%; 1-year: 36.4% vs 10.7%).
• The rate of reintubation was significantly higher for patients with fibrosis (9.1% vs 2.9%, p = 0.038). 
• Post-operative length of stay between groups was almost similar with 6 days for the fibrosis group and 5 days for the non-fibrosis group.
• Pulmonary fibrosis patients had significantly overall less survival (log-rank analysis, p < 0.001).

The study shows that short and long-term outcomes after lung resection are worse for patients with pre-existing pulmonary fibrosis. 

Further reading: https://doi.org/10.1016/j.rmed.2022.107037 

Garner M, Taylor M, Smith M, et al Pre-existing pulmonary fibrosis is associated with adverse outcomes after lung resection. Respiratory Medicine, 205:107037;2022.