Author of

• 11595

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  P2.07 - Poster Session 2 - Surgery (ID 190)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11606

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    P2.07-011 - A pilot study on the effects of perioperartive administration of the neutrophil elastase inhibitor, Sivelestat, to non-small cell lung cancer patients with preoperative risk factors of acute respiratory distress syndrome after pulmonary resection (ID 1217)

    09:30 - 09:30  |  Author(s): T. Kometani
    • Abstract

    Background
    Postoperative acute respiratory distress syndrome (ARDS) is a recognized complication of pulmonary resection. ARDS following lung resection has a miserable prognosis, with overall hospital mortality rates over 25%. Previous studies demonstrated that there were risk factors of ARDS after pulmonary resection including age, chronic obstructive pulmonary disease (COPD), interstitial pneumonia, concurrent cardiac disease, prior therapy, remaining lung perfusion, duration of operation, increased blood loss and so on. Neutrophils and neutrophil elastase (NE) are believed to play a key role in the endothelial injury and increased vascular permeability characteristic of ARDS. Sivelestat sodium hydrate is a selective NE inhibitor and has been shown to improve respiratory status in cases of ARDS. It has not been well known whether or not NE inhibitors are beneficial for prevention of ARDS after lung resection.

    Methods
    We conducted a pilot study to investigate the efficacy of perioperative administration of sivelestat sodium hydrate to prevent postoperative ARDS in 34 non-small cell lung cancer (NSCLC) patients who had the various preoperative risk factors of the incidence of ARDS after pulmonary resection in Chiba University between 2009 and 2011. They received sivelestat sodium hydrate (5mg/kg/day) intravenously for 7 days starting at the beginning of operation.

    Results
    The patient demographics were as follows: median age, 68 years of age (range 47 to 83 years), male/female ratio, 31/3, clinical stage I/II/III, 9/6/19. The histology was adenocarcinoma (n =19), squamous cell carcinoma (n=10) and others (n =5). Risk factors of ARDS included induction chemotherapy (n=3), induction chemoradiotherapy (n=17), interstitial pneumonia (n=10), COPD (n=3) and medical history of ARDS (n=1). All 34 patients underwent complete resection. The operations included 2 partial resections, 31 lobectomies, and 1 pneumonectomy. Of the 31 patients who received lobectomy, bronchial or arterial plasty was performed in 9 patients. The postoperative mortality rate was 2.9%. One patient died of heart failure on the nineth postoperative day. There was no incidence of ARDS after pulmonary resection in all patients.

    Conclusion
    Perioperative administration of sivelestat sodium hydrate can be beneficial to prevent postoperative ARDS in NSCLC patients. Prospective studies are required.