Repeated Lung Cancer Surgery in IPF Patients May Worsen Outcomes

Surgery for lung cancer should be carefully considered in patients who also have idiopathic pulmonary fibrosis (IPF), because it is associated with poor outcomes, a study shows.

The study, “Survival after repeated surgery for lung cancer with idiopathic pulmonary fibrosis: a retrospective study,” was published in the journal BMC Pulmonary Medicine.

Patients with IPF have a higher risk for lung cancer than the general population. They also have a greater chance of having a second lung cancer after their first one has been successfully removed.

The reason behind the poor outcomes might be the poor prognosis of IPF itself and the worsening of the symptoms after each intervention. However, repeated surgery has not been investigated as a risk factor for these patients.

In this retrospective study, researchers from Japan investigated the clinical outcomes of lung cancer patients with IPF who received a second pulmonary resection (surgical removal of a lung tumor).

Medical records were reviewed to obtain demographic and clinical characteristics of patients, type of surgery, outcomes after surgery, and survival. Measures of lung function – including vital capacity (%VC) and forced expiratory volume in one second (FEV1%) – and chest CT scans also were included in the analysis.

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The study included 108 patients, 17 of whom developed a second primary lung cancer. Of those, 13 received a second lung resection, and the remaining received radiation therapy, chemotherapy, or best supportive (palliative) care.

Researchers found that 23.1 percent of patients who received a second surgery developed an acute exacerbation of IPF symptoms and died. Lung function in these patients — measured by %VC — was significantly lower than in those without exacerbations.

Three years after surgery, the overall survival rate was 34.6 percent. Among the 11 deaths, seven were cancer-related, three were due to acute exacerbations of IPF, and one was caused by metachronous lung cancer, a type of cancer that develops after resection of another cancer.

The findings show that a second surgery for lung cancer in IPF patients might lead to worse outcomes and should be carefully considered by physicians before they proceed.

“Repeated surgery for patients with lung cancer and concomitant IPF could increase the risk of acute exacerbation development despite limited surgery,” researchers said.

“Although these results demonstrated that surgical intervention for multiple primary lung cancers might be contraindicated in patients with IPF, selection of patients who may benefit from such treatment is very important. To confirm these findings, a large, long-term, multi-center surveillance study will be required,” they concluded.