Pulmonology Xagena

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Perioperative Pirfenidone treatment is effectiveness in preventing postoperative acute exacerbation of idiopathic pulmonary fibrosis in IPF patients with lung cancer

Idiopathic pulmonary fibrosis ( IPF ) is a progressive diffuse lung disease associated with an increased risk of lung cancer. Patients with idiopathic pulmonary fibrosis sometimes develop a life-threatening acute exacerbation ( AE-IPF ) after lung cancer surgery.
In this retrospective study, Pirfenidone ( Esbriet ), 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.

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 perioperative Pirfenidone treatment were analyzed as historical controls.

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 acute exacerbation of idiopathic pulmonary fibrosis ( P = 0.0167 ).

A quantitative histopathological evaluation of resected lung specimens found that tissue changes associated with idiopathic pulmonary fibrosis were significantly fewer in the PPT patients ( P = 0.021 ).

In conclusion, perioperative Pirfenidone treatment is feasible for IPF patients with lung cancer. Its effectiveness in preventing postoperative acute exacerbation of IPF thus warrants prospective verification. ( Xagena )

Iwata T et al, Surg Today 2015;45:1263-1270