Clinical results of sublobar resection versus lobectomy or more extensive resection for lung cancer patients with idiopathic pulmonary fibrosis

Abstract

Background: Lung cancer patients with idiopathic pulmonary fibrosis (IPF) are at a high risk of requiring lung resection. The optimal surgical strategy for these patients remains unclear. This study aimed to compare the clinical results of a sublobar resection versus a lobectomy or more extensive resection for lung cancer in patients with IPF. Methods: From January 1995 to December 2012, 80 patients with simultaneous non-small cell lung cancer and IPF were treated surgically at Asan Medical Center. Predictors of recurrence-free survival and overall survival were evaluated in the series. Results: Lobectomy or more extensive resection of the lung (lobar resection group) was performed in 65 patients and sublobar resection (sublobar resection group) was carried out in 15 patients. The sublobar resection group showed fewer in-hospital mortalities than the lobar resection group (6.7% vs. 15.4%; P= 0.68). For late mortality after lung resection, cancer-related deaths were not significantly different in incidence between the two groups (55.6% vs. 30.6%; P= 0.18). Recurrence-free survival after lung resection was significantly greater in the lobar than in the sublobar resection group (P= 0.01). However, overall survival after lung resection was not significantly different between the two groups (P= 0.05). Sublobar resection was not a significant predictive factor for overall survival (hazard ratio = 0.50; 95% CI: 0.21-1.15; P= 0.10). Conclusions: Although not statistically significant, a sublobar resection results in less in-hospital mortality than a lobar resection for lung cancer patients with IPF. There is no significant difference in overall survival compared with lobar resection. A sublobar resection may be another therapeutic option for lung cancer patients with IPF.