Surgical intervention for pulmonary tuberculosis: analysis of indications and perioperative data relating to diagnostic and therapeutic resections

• Published in: European journal of cardio-thoracic surgery Vol. 20; no. 4; pp. 722 - 727
• Main Authors: FurÁk, József, TrojÁn, Imre, Szöke, TamÁs, Tiszlavicz, LÁszló, Morvay, Zita, Csada, Edit, Balogh, ÁdÁm
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Science B.V 01-10-2001; Elsevier Science
• Subjects: Adult; Aged; Antibiotics, Antitubercular - administration & dosage; Antibiotics, Antitubercular - adverse effects; Biological and medical sciences; Biopsy; Combined Modality Therapy; Diagnostic resection; Endobronchial tuberculosis; Female; Follow-Up Studies; Humans; Lung - pathology; Male; Medical sciences; Middle Aged; Pneumonectomy; Postoperative Complications - drug therapy; Postoperative Complications - mortality; Postoperative Complications - pathology; Postoperative Complications - surgery; Premedication; Preoperative antituberculotic treatment; Pulmonary tuberculosis; Recurrence; Reoperation; Retrospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the respiratory system; Survival Rate; Thoracic Surgery, Video-Assisted; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - mortality; Tuberculosis, Pulmonary - pathology; Tuberculosis, Pulmonary - surgery; Diagnostic resection; Endobronchial tuberculosis; Preoperative antituberculotic treatment; Pulmonary tuberculosis; Human; Lung disease; Respiratory disease; Lung; Surgical resection; Mycobacterial infection; Infection; Chemotherapy; Treatment; Tuberculosis; Surgery; Bacteriosis; Antituberculous agent; Preoperative
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(01)00874-0

Objective: To analyze the data on patients operated on for pulmonary tuberculosis (TB) with (Group I) or without (Group II) a correct TB diagnosis and preoperative anti-TB treatment. Methods: Between 1980 and 1997, 144 resections for TB (Groups I+II) were performed. The 80 patients in Group I underwent therapeutic resections: 32 cases involved recurrent cavities or tuberculomas, three involved post-TB bronchiectasis, 13 involved progression of cavities or tuberculomas, and 32 involved persistent tuberculomas after 6 months of anti-TB therapy. The 64 patients in Group II were operated on for a suspicion of malignancy in 49 cases, for cavitary lesions with haemophthysis in six cases, for multiple lesions in seven cases, and for recurrent hydrothorax in two cases. Results: Groups I and II included 0 and five pneumonectomies, 32 and 29 lobectomies, 48 and 20 wedge resections, 0 and nine videothoracoscopic biopsies, and 0 and one hilar lymphadenectomy, respectively. In Groups I and II, the mean duration of postoperative hospitalization was 13.2 and 10.4 days, and the frequency of postoperative pneumothorax was 11.25 and 4.6%, respectively. The incidence of bronchopleural fistula was 1.25 and 0%, the mortality was 0 and 3.1%, and the morbidity was 53.7 and 35.9% in Groups I and II, respectively. Two patients with active disease died in Group II. Pathology demonstrated that the frequency of acid-fast bacilli in Groups I and II was 40 and 25%, respectively. Conclusions: Patients without a correct preoperative TB diagnosis underwent more extensive parenchyma resection. Postoperative complications increased when acid-fast bacilli were present. The lack of preoperative anti-TB treatment did not involve a higher risk of minor complications, but death occurred only in this group.