Postoperative pleurodesis using OK-432 for pulmonary air leak in lung cancer patients with idiopathic interstitial pneumonia: A retrospective study.

[PURPOSE] To evaluate the efficacy and safety of postoperative pleurodesis using OK-432, focusing on patients with idiopathic interstitial pneumonia (IIP).

[METHODS] This retrospective cohort study included patients who underwent OK-432 pleurodesis following pulmonary resection. We reviewed clinical characteristics, radiological evidence of IIP, operative findings, postoperative air leak volume, pleurodesis details, morbidity, and mortality; then we compared the outcomes of patients with vs. those without IIP, and analyzed the predictors of ≥Grade II complications.

[RESULTS] Pleurodesis was performed in 361 patients, including 67 (19%) with IIP. No significant differences were observed in the incidence of fever or in postpleurodesis parameters. The initial success rate was 58.2% for IIP patients and 70.4% for non-IIP patients. Recurrence developed in 7.5% of patients and surgical intervention was required in 4.1%. Risk factors for ≥Grade II complications included older age, IIP, pleurodesis within 3 postoperative days (PODs), and pre-pleurodesis WBC > 7000/µL. Pneumonia after pleurodesis was more frequent in the IIP patients (11.9% vs. 2.4%, p < 0.01).

[CONCLUSIONS] There were no treatment-related deaths following OK-432 pleurodesis in IIP patients; however, IIP remained a significant risk factor for pleurodesis-related complications, particularly pneumonia. Early intervention and elevated WBC levels may increase the complication risk. Delaying pleurodesis until the WBC count normalizes is advisable to reduce adverse events.