The maximum dimension of the inferior vena cava is a significant predictor of postoperative mortality in lung cancer patients with idiopathic interstitial pneumonia

  • Mariko Fukui
  • Kazuya Takamochi
  • Kazuhiro Suzuki
  • Akihiro Hotta
  • Katsutoshi Ando
  • Takeshi Matsunaga
  • Shiaki Oh
  • Izumi Kawagoe
  • Kenji SuzukiEmail author
Original Article



Several vascular measurements in computed tomography (CT) were reported to be indicators of pulmonary hypertension in chronic obstructive pulmonary disease (COPD) patients. We evaluated the usefulness of these parameters as predictors of postoperative mortality in lung cancer patients with IIP.


This retrospective study was performed on 1888 patients. The following CT findings were evaluated: diameter of the main pulmonary artery, ascending aorta, and the short axis of the inferior vena cava (IVC). Univariate and multivariate analyses were conducted to determine predictors of surgical mortality.


In the IIP patients, the 90-day mortality was 0.8%, and the 2-year mortality was 5.8%. Regarding the 90-day mortality in patients with IIP, a multivariate analysis revealed a short axis of IVC > 21 mm [odds ratio (OR) 6.4, p < 0.01) and the risk score reported by Japanese Association for Chest Surgery (JACS) (OR 1.4, p = 0.01) as independent predictors. Regarding the 2-year mortality in patients with IIP, a multivariate analysis revealed IVC > 21 mm (OR 2.3, p < 0.04), %VC < 80% (OR 2.4, p = 0.02), and pathological cancer stages II and III vs. I (OR 7.2, p < 0.001) as independent predictors.


Enlargement of the IVC as measured by CT was a significant predictor of mortality after surgery for lung cancer with IIP patients.


Inferior vena cava Idiopathic interstitial pneumonia Lung cancer Surgical mortality 


Compliance with ethical standards

Conflict of interest

None declared.


  1. 1.
    Licker M, de Perrot M, Spiliopoulos A, Robert J, Diaper J, Chevalley C et al. Risk factors for acute lung injury after thoracic surgery for lung cancer. Anesth Analg 2003;97:1558–1565.CrossRefGoogle Scholar
  2. 2.
    Saito Y, Kawai Y, Takahashi N, Ikeya T, Murai K, Kawabata Y, et al. Survival after surgery for pathologic stage IA non-small cell lung cancer associated with idiopathic pulmonary fibrosis. Ann Thorac Surg. 2011;92:1812–7.CrossRefGoogle Scholar
  3. 3.
    Watanabe A, Higami T, Ohori S, Koyanagi T, Nakashima S, Mawatari T. Is lung cancer resection indicated in patients with idiopathic pulmonary fibrosis? J Thorac Cardiovasc Surg. 2008;136:1357–63.CrossRefGoogle Scholar
  4. 4.
    Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 2011;183:788–824.CrossRefGoogle Scholar
  5. 5.
    Pitsiou G, Papakosta D, Bouros D. Pulmonary hypertension in idiopathic pulmonary fibrosis: a review. Respir Int Rev Thorac Dis. 2011;82:294–304.Google Scholar
  6. 6.
    Iyer AS, Wells JM, Vishin S, Bhatt SP, Wille KM, Dransfield MT. CT scan-measured pulmonary artery to aorta ratio and echocardiography for detecting pulmonary hypertension in severe COPD. Chest. 2014;145:824–32.CrossRefGoogle Scholar
  7. 7.
    Chen X, Liu K, Wang Z, Zhu Y, Zhao Y, Kong H, et al. Computed tomography measurement of pulmonary artery for diagnosis of COPD and its comorbidity pulmonary hypertension. Int J Chronic Obstr Pulm Dis. 2015;10:2525–33.CrossRefGoogle Scholar
  8. 8.
    Yanagawa Y, Nishi K, Sakamoto T, Okada Y. Early diagnosis of hypovolemic shock by sonographic measurement of inferior vena cava in trauma patients. J Trauma. 2005;58:825–9.CrossRefGoogle Scholar
  9. 9.
    Liao YY, Lin HJ, Lu YH, Foo NP, Guo HR, Chen KT. Does CT evidence of a flat inferior vena cava indicate hypovolemia in blunt trauma patients with solid organ injuries? J Trauma. 2011;70:1358–61.CrossRefGoogle Scholar
  10. 10.
    Sato T, Teramukai S, Kondo H, Watanabe A, Ebina M, Kishi K, et al. Impact and predictors of acute exacerbation of interstitial lung diseases after pulmonary resection for lung cancer. J Thorac Cardiovasc Surg. 2014;147:1604–1611.CrossRefGoogle Scholar
  11. 11.
    Kumar P, Goldstraw P, Yamada K, Nicholson AG, Wells AU, Hansell DM, et al. Pulmonary fibrosis and lung cancer: risk and benefit analysis of pulmonary resection. J Thorac Cardiovasc Surg. 2003;125:1321–27.CrossRefGoogle Scholar
  12. 12.
    Colice GL, Shafazand S, Griffin JP, Keenan R, Bolliger CT, American College of Chest P. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest 2007;132:161S–177S.CrossRefGoogle Scholar
  13. 13.
    Sato T, Kondo H, Watanabe A, Nakajima J, Niwa H, Horio H, et al. A simple risk scoring system for predicting acute exacerbation of interstitial pneumonia after pulmonary resection in lung cancer patients. Gen Thorac Cardiovasc Surg. 2015;63:164–72.CrossRefGoogle Scholar
  14. 14.
    Fukui M, Suzuki K, Oh S, Matsunaga T, Miyasaka Y, Kawagoe I, et al. Distribution of interstitial pneumonia: a new radiological predictor of 90-day mortality after resection of lung cancer. Surg Today. 2016;46:66–73.CrossRefGoogle Scholar
  15. 15.
    Sato T, Watanabe A, Kondo H, Kanzaki M, Okubo K, Yokoi K, et al. Long-term results and predictors of survival after surgical resection of patients with lung cancer and interstitial lung diseases. J Thorac Cardiovasc Surg 2015;149:64–9.CrossRefGoogle Scholar
  16. 16.
    Kimura M, Taniguchi H, Kondoh Y, Kimura T, Kataoka K, Nishiyama O, et al. Pulmonary hypertension as a prognostic indicator at the initial evaluation in idiopathic pulmonary fibrosis. Respir Int Rev Thorac Dis. 2013;85:456–63.Google Scholar
  17. 17.
    Cottin V, Cordier JF. The syndrome of combined pulmonary fibrosis and emphysema. Chest. 2009;136:1–2.CrossRefGoogle Scholar
  18. 18.
    Shen Y, Wan C, Tian P, Wu Y, Li X, Yang T, et al. CT-base pulmonary artery measurement in the detection of pulmonary hypertension: a meta-analysis and systematic review. Medicine. 2014;93:e256.CrossRefGoogle Scholar
  19. 19.
    Ng CS, Wells AU, Padley SP. A CT sign of chronic pulmonary arterial hypertension: the ratio of main pulmonary artery to aortic diameter. J Thorac Imaging. 1999;14:270–8.CrossRefGoogle Scholar
  20. 20.
    Dalleywater W, Powell HA, Hubbard RB, Navaratnam V. Risk factors for cardiovascular disease in people with idiopathic pulmonary fibrosis: a population-based study. Chest. 2015;147:150–56.CrossRefGoogle Scholar
  21. 21.
    Hubbard RB, Smith C, Le Jeune I, Gribbin J, Fogarty AW. The association between idiopathic pulmonary fibrosis and vascular disease: a population-based study. Am J Respir Crit Care Med. 2008;178:1257–61.CrossRefGoogle Scholar
  22. 22.
    Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16:233–70.CrossRefGoogle Scholar
  23. 23.
    Brennan JM, Blair JE, Goonewardena S, Ronan A, Shah D, Vasaiwala S, et al. Reappraisal of the use of inferior vena cava for estimating right atrial pressure. J Am Soc Echocardiogr. 2007;20:857–61.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Mariko Fukui
    • 1
  • Kazuya Takamochi
    • 1
  • Kazuhiro Suzuki
    • 2
  • Akihiro Hotta
    • 2
  • Katsutoshi Ando
    • 3
  • Takeshi Matsunaga
    • 1
  • Shiaki Oh
    • 1
  • Izumi Kawagoe
    • 4
  • Kenji Suzuki
    • 1
    Email author
  1. 1.Department of General Thoracic SurgeryJuntendo University School of MedicineTokyoJapan
  2. 2.Department of RadiologyJuntendo University School of MedicineTokyoJapan
  3. 3.Department of Respiratory MedicineJuntendo University School of MedicineTokyoJapan
  4. 4.Department of AnesthesiologyJuntendo University School of MedicineTokyoJapan

Personalised recommendations