Is operation safe for lung cancer patients with interstitial lung disease on computed tomography?

Aims: Interstitial lung disease (ILD) is associated with the incidence of non-small cell lung cancer (NSCLC). Patients with ILD are at risk of acute exacerbation (AE) after pulmonary resection. However, there have been no recognized treatment guidelines for NSCLC patients with ILD on computed tomography (CT). Methods: We reviewed the medical records of 156 consecutive patients with ILD on high-resolution CT who have undergone pulmonary resection and between 2014 and 2018. Data regarding general information, imaging features, perioperative indicators, and long-term prognosis of patients were compared. Results: The mean patient age was 67.24 +/- 6.80 years. Postoperative AE occurred in seven (4.5%) patients; five (71.4%) of the seven patients who had an AE died within 30 days. The incidence of postoperative AE was 5.3% among patients who underwent lobectomy (n = 6). Overall survivals (OS) was significantly poorer in patients with possible usual interstitial pneumonia (UIP)/UIP [hazard ratio (HR) 2.34, 95% confidence interval (CI) 1.11-4.95, p = 0.026] and severe postoperative complications (Grade > 3) (versus no complication: HR 2.58, 95% CI 1.11-6.02, p = 0.028; versus mild complications: HR 6.05, 95% CI 2.69-13.6, p < 0.001). Age (HR 1.071, 95% CI 1.006-1.137, p = 0.030) and ILD patterns (HR 2.420, 95% CI 1.024-5.716, p = 0.044) were independent prognostic factors for OS. Forced vital capacity (FVC) (odds ratio 0.351, 95% CI 0.145-0.850, p = 0.020) was an independent prognostic factor for patients who needed postoperative intensive care unit intervention. Conclusion: Pulmonary resection for NSCLC Patients with ILD on CT is a safe procedure. However, surgical indications for lobectomy need to be more carefully for these patients, especially for possible UIP/UIP patients and patients with lower FVC. The reviews of this paper are available via the supplemental material section.