Outcomes of Video-Assisted Thoracic Surgical Lung Biopsy for Interstitial Lung Diseases

Abstract

Purpose: Surgical lung biopsy (SLB) is an important diagnostic tool for interstitial lung disease (ILD), yet the risk factors for SLB are still debatable and long-term outcomes remain unknown. Methods: We retrospectively reviewed the records of 85 consecutive patients with ILD who underwent SLB by video-assisted thoracic surgery (VATS) from 2008 to 2019. Risk factors for complications and differences of outcomes between idiopathic pulmonary fibrosis (IPF) and other ILDs were examined. Results: All patients who underwent VATS had no mortality or acute exacerbation of ILD within 90 days of SLB. The rate of complication was 9.4%, and there were no statistically significant risk factors for complications. While the IPF group was not significantly different from the non-IPF group with regard to surgical parameters or complications, patients with IPF had significantly higher rates of mortality (50% vs. 9% in 5 years; p <0.001) and readmission due to acute exacerbation (75% vs. 8% in 5 years; p <0.001). Conclusion: VATS lung biopsy for ILD can be a safe approach regardless of underlying phenotypes. An accurate diagnosis of IPF via SLB may be beneficial for correct patient management.

Surgical lung biopsy for suspected interstitial lung disease with video-assisted thoracoscopic surgery is safe, providing exact histological and disease specific diagnosis for tailoring treatment

“…Other complications were minor, most often pulmonary infections, and occurred in 10.3% of cases. Similar complications rates have been reported in other studies, or ranging from 9.4% to 30% for minor complications, and 0% to 7.7% for major complications ( 25 - 28 ).…”

“…We, however, reported a lower age at diagnosis for both UIP (65.9 years) and the whole patient cohort (55.6 years), which is slightly lower in comparison with a previous study from Iceland where it was 58 years in patients operated between 1986 and 2007 ( 24 ). In other similar studies the mean age ranges between 68 and 73 years; which is considerably higher than in the current study ( 22 , 23 , 25 ). Furthermore, our NSIP patients were on average 10 years younger than those with UIP.…”

“…Only 2 out of 68 patients had to be converted to mini-thoracotomy, which is as comparable rate to other studies as was the length of chest tube drainage (1 day median) and postoperative stay (2 days median) ( 25 , 26 , 28 ). In patients with severe hypoxemia, a mini-thoracotomy has been suggested over double-lumen intubation with single lung ventilation, as it eases the application of continuous positive airway pressure (CPAP), inspiratory positive airway pressure (IPAP) and partial lung ventilation techniques ( 29 ).…”

Outcomes Following Surgical Lung Biopsy for Interstitial Lung Diseases: A Monocenter Experience

“…8,10,11,19 However, recent series documented mortality rates at 30 days lower than 5% following elective SLB for ILD. [20][21][22][23][24] Consistent with these findings, we documented that none of the patients in the present series died within 30 days (including nonelective SLB). However, 2 patients died of SLB-related complications between days 30 and 90.…”

“…This is also consistent with previous series that reported exacerbation rates ranging from 0 to 10.7%. 10,11,19,20,25 In addition to differences in baseline characteristics and the surgical procedures, the lack of widely accepted definition of acute exacerbation likely contributed to the variability of previously described exacerbation rates, especially in the postoperative settings. In practice, concomitant infection can rarely by completely excluded with confidence, whereas congestive heart failure is also frequently diagnosed concomitantly.…”