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Advantages and disadvantages of corticosteroid use for acute exacerbation of interstitial pneumonia after pulmonary resection

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Abstract

Objectives

Acute exacerbation of interstitial pneumonia (AE-IP) is the top cause of 30-day mortality in surgery for lung cancer patients. The general treatment for AE-IP is corticosteroid; however, there are some disadvantages of corticosteroid use after surgery. This study was conducted to report the clinical course of AE-IP after surgery and evaluate the effect of corticosteroid use.

Methods

This retrospective study was performed on 337 patients with interstitial pneumonia who underwent surgical resection for lung cancer at our institute between 2009 and 2018. AE-IP were observed in 14 patients (4.2%) and their management and clinical outcome were investigated.

Results

All patients received methylprednisolone pulse therapy. Six patients (42.9%) became convalescent after pulse therapy and eight (57.1%) died within 90 days after surgery due to lack of therapeutic efficacy. Oxygenation and ground-glass opacities of the survivors improved within 3 days after starting pulse therapy. Patients who responded to the first pulse also responded to the second pulse. Four patients developed complications including two with bronchopulmonary fistulas that may be related to steroid treatment. Even if the corticosteroid was effective, all AE-IP patients died within 1 year after surgery.

Conclusions

Corticosteroid therapy is effective for AE-IP after surgery; however, it may lead to severe complications after surgery.

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Funding

This study was supported in part by a Grant in Aid for Cancer Research from the Ministry of Health, Labor and Welfare of Japan and the Smoking Research Foundation.

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Authors and Affiliations

  1. Departments of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hondo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan

    Mariko Fukui, Kazuya Takamochi, Takeshi Matsunaga, Aritoshi Hattori, Shiaki Oh & Kenji Suzuki

  2. Departments of Radiology, Juntendo University School of Medicine, Tokyo, Japan

    Kazuhiro Suzuki

  3. Department of Respiratory Medicine, Juntendo University School of Medicine, Tokyo, Japan

    Katsutoshi Ando

Authors
  1. Mariko Fukui
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  2. Kazuya Takamochi
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  3. Kazuhiro Suzuki
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  4. Katsutoshi Ando
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  5. Takeshi Matsunaga
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  6. Aritoshi Hattori
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  7. Shiaki Oh
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  8. Kenji Suzuki
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Correspondence to Mariko Fukui.

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Fukui, M., Takamochi, K., Suzuki, K. et al. Advantages and disadvantages of corticosteroid use for acute exacerbation of interstitial pneumonia after pulmonary resection. Gen Thorac Cardiovasc Surg 69, 472–477 (2021). https://doi.org/10.1007/s11748-020-01487-z

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  • DOI: https://doi.org/10.1007/s11748-020-01487-z

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