Akın Eraslan Balci1, Tansel Ansal Balci2, Mehmet Oğuzhan Ozyurtan3. 1. Department of Thoracic Surgery, Euphrates University Hospital, Elazig, Turkey. Electronic address: abalci.journals@hotmail.com. 2. Department of Nuclear Medicine, Euphrates University Hospital, Elazig, Turkey. 3. Department of Thoracic Surgery, Euphrates University Hospital, Elazig, Turkey.
Abstract
BACKGROUND: This study retrospectively evaluated the surgical indications and outcomes of 86 patients with bronchiectasis. METHODS: Between 2000 and 2013, the clinical and surgical specifications as well as follow-up results of patients with bronchiectasis were reviewed. Cystic and cylindric morphologic features were determined by chest computed tomography and hemodynamics (perfused and nonperfused), by lung ventilation/perfusion scans. The main indication for surgical resection was localized areas of cystic, nonperfused bronchiectasis. RESULTS: Patients were a mean age of 37.8 ± 14.5 years. Symptom duration was 43.4 ± 36.9 months. Bronchiectasis was saccular in 66 patients (76.7%) and varicose in 20 (23.3%). Localized defects were limited in one region of the lung in 53 (61.6%), and 54 (62.8%) showed a mixed or an obstructive ventilatory pattern. Failure of medical therapy was the most common indication for pulmonary resection. The 86 patients underwent 98 operations. Ten underwent staged thoracotomies (contralateral lobectomy, 7; contralateral segmentectomy, 3). Complete resection of all bronchiectatic areas was done in 78 patients (90.7%). Complications developed in 14 patients (14.6%). The mortality rate was 1.1% (n = 1). After surgical treatment, 71 of 86 patients (82.5%) were free of symptoms (excellent), and the remaining 15 (17.5%) had a reduction in preoperative symptoms. The 53 patients with localized perfusion defects underwent complete resection and had symptom-free (excellent) postoperative results. Complete resection independently predicted symptom-free outcome (p < 0.05); a forced expiratory volume in 1 second of less than 60% of the predicted value, an incomplete resection, and a preoperative antibiotic therapy independently predicted postoperative complications (p < 0.05). CONCLUSIONS: Bronchiectasis can be improved with operation. In properly selected patients, pulmonary resection can be done with acceptable morbidity and mortality rates and can lead to lasting symptomatic improvements.
BACKGROUND: This study retrospectively evaluated the surgical indications and outcomes of 86 patients with bronchiectasis. METHODS: Between 2000 and 2013, the clinical and surgical specifications as well as follow-up results of patients with bronchiectasis were reviewed. Cystic and cylindric morphologic features were determined by chest computed tomography and hemodynamics (perfused and nonperfused), by lung ventilation/perfusion scans. The main indication for surgical resection was localized areas of cystic, nonperfused bronchiectasis. RESULTS:Patients were a mean age of 37.8 ± 14.5 years. Symptom duration was 43.4 ± 36.9 months. Bronchiectasis was saccular in 66 patients (76.7%) and varicose in 20 (23.3%). Localized defects were limited in one region of the lung in 53 (61.6%), and 54 (62.8%) showed a mixed or an obstructive ventilatory pattern. Failure of medical therapy was the most common indication for pulmonary resection. The 86 patients underwent 98 operations. Ten underwent staged thoracotomies (contralateral lobectomy, 7; contralateral segmentectomy, 3). Complete resection of all bronchiectatic areas was done in 78 patients (90.7%). Complications developed in 14 patients (14.6%). The mortality rate was 1.1% (n = 1). After surgical treatment, 71 of 86 patients (82.5%) were free of symptoms (excellent), and the remaining 15 (17.5%) had a reduction in preoperative symptoms. The 53 patients with localized perfusion defects underwent complete resection and had symptom-free (excellent) postoperative results. Complete resection independently predicted symptom-free outcome (p < 0.05); a forced expiratory volume in 1 second of less than 60% of the predicted value, an incomplete resection, and a preoperative antibiotic therapy independently predicted postoperative complications (p < 0.05). CONCLUSIONS:Bronchiectasis can be improved with operation. In properly selected patients, pulmonary resection can be done with acceptable morbidity and mortality rates and can lead to lasting symptomatic improvements.
Authors: Hamdan Al-Jahdali; Abdullah Alshimemeri; Abdullah Mobeireek; Amr S Albanna; Nehad N Al Shirawi; Siraj Wali; Khaled Alkattan; Abdulrahman A Alrajhi; Khalid Mobaireek; Hassan S Alorainy; Mohamed S Al-Hajjaj; Anne B Chang; Stefano Aliberti Journal: Ann Thorac Med Date: 2017 Jul-Sep Impact factor: 2.219