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Experience with perioperative pirfenidone for lung cancer surgery in patients with idiopathic pulmonary fibrosis

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Abstract

Purpose

Idiopathic pulmonary fibrosis (IPF) is a progressive diffuse lung disease associated with an increased risk of lung cancer. Patients with IPF sometimes develop a life-threatening acute exacerbation of IPF (AE-IPF) after lung cancer surgery. In this retrospective study, pirfenidone, an antifibrotic agent, was perioperatively administered to IPF patients with lung cancer with the aim of preventing postoperative AE-IPF, and the feasibility and clinical outcomes were investigated.

Methods

Twelve IPF patients with concomitant lung cancer who received perioperative pirfenidone treatment (PPT) for lung cancer surgery were retrospectively investigated. Sixteen IPF patients undergoing lung cancer surgery without PPT were analyzed as historical controls.

Results

Compared to the controls, the PPT patients had a more severely impaired preoperative pulmonary function and a larger number of limited pulmonary resections. There was a significant preoperative decrease in the serum KL-6 levels of the PPT patients. No severe pirfenidone-related complications or IPF-related events occurred in the PPT patients, while six control patients developed AE-IPF (P = 0.0167). A quantitative histopathological evaluation of resected lung specimens found that tissue changes associated with IPF were significantly fewer in the PPT patients (P = 0.021).

Conclusions

PPT is a feasible perioperative treatment for IPF patients with lung cancer. Its effectiveness in preventing postoperative AE-IPF thus warrants prospective verification.

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Conflict of interest

IY received a research grant from Shionogi & Co. Ltd for the other purpose than this study; all other authors have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba, Chiba, 260-8670, Japan

    Takekazu Iwata, Shigetoshi Yoshida, Kaoru Nagato, Takahiro Nakajima, Hidemi Suzuki, Tetsuzo Tagawa, Teruaki Mizobuchi & Ichiro Yoshino

  2. Department of Diagnostic Pathology, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba, Chiba, 260-8670, Japan

    Satoshi Ota & Yukio Nakatani

Authors
  1. Takekazu Iwata
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  2. Shigetoshi Yoshida
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  3. Kaoru Nagato
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  4. Takahiro Nakajima
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  5. Hidemi Suzuki
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  6. Tetsuzo Tagawa
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  7. Teruaki Mizobuchi
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  8. Satoshi Ota
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  9. Yukio Nakatani
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  10. Ichiro Yoshino
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Corresponding author

Correspondence to Shigetoshi Yoshida.

Additional information

T. Iwata and S. Yoshida contributed equally.

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Iwata, T., Yoshida, S., Nagato, K. et al. Experience with perioperative pirfenidone for lung cancer surgery in patients with idiopathic pulmonary fibrosis. Surg Today 45, 1263–1270 (2015). https://doi.org/10.1007/s00595-014-1071-5

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  • DOI: https://doi.org/10.1007/s00595-014-1071-5

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