Development of scoring system for the prediction of pulmonary complications following curative resection in lung cancer with idiopathic pulmonary

Background: Surgical treatment of lung cancer in idiopathic pulmonary fibrosis is associated with substantial rate of postoperative pulmonary complications (PPCs) which may be fatal. We aimed to determine the prevalence and risk factors of PPCs and to develop a novel scoring system to predict them. Methods: In this retrospective study, we analyzed clinical data for 204 patients with IPF who underwent curative surgery for NSCLC between 1996 and 2020. Risk factors of postoperative pulmonary complications were determined by multivariate logistic regression analysis. Results: Most patients were male (n=183, 90%), and the median (interquartile range) age was 68 (63–72) years. Squamous cell carcinoma was the most common (50%), followed by adenocarcinoma (40%). Majority of patients received lobectomy (88%). PPCs developed in 75 patients (37%), which include acute lung injury (n=29, 14%), pneumonia (n=19, 10%), pneumothorax (n=14, 7%) and prolonged air leak (n=13, 6%). Compared to patients without PPCs, those with PPCs were more likely to be older, have diabetes, have lower lung function, and lower serum albumin, and undergo surgery other than wedge resection. On multivariate analysis, old age, diabetes, high ASA scores, lower DLco, and surgery other than wedge resection were independently associated with PPC development. The area under ROC curve for the prediction of PPCs based on the five variables was 0.7681. Conclusions: PPCs frequently developed in patients with IPF who received curative resection for NSCLC. Old age, diabetes, high ASA score, low DLco, and extent of surgery were predictors of PPC development.