• Takekazu Iwata, Shigetoshi Yoshida, Kaoru Nagato, Takahiro Nakajima, Hidemi Suzuki, Tetsuzo Tagawa, Teruaki Mizobuchi, Satoshi Ota, Yukio Nakatani, and Ichiro Yoshino.
• Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba, Chiba, 260-8670, Japan. takeiwata-ths@umin.ac.jp.
• Surg. Today. 2015 Oct 1; 45 (10): 1263-70.

PurposeIdiopathic 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.MethodsTwelve 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.ResultsCompared 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).ConclusionsPPT 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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