Pradheep Krishnamohan1, K Robert Shen1, Dennis A Wigle1, Mark S Allen1, Francis C Nichols1, Stephen D Cassivi1, William S Harmsen2, Claude Deschamps3. 1. Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota. 2. Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota. 3. Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: deschamps.claude@mayo.edu.
Abstract
BACKGROUND: Giant bullae of the lung are rare. Little is known about functional results after surgical treatment. METHODS: This study retrospectively reviewed all patients who underwent surgical treatment for giant bullae between December 1988 and December 2010. RESULTS: There were 63 patients (51 men, 12 women) with a median age of 56 years (range, 26 to 85 years). Bullae were a median size of 14 cm (range, 9 to 30 cm). Forty-five patients (71%) had underlying diffuse emphysema. The indication for surgical intervention was symptoms alone in 30 patients (48%) and associated complications in 33 (52%). The operation was a bullectomy in 54 patients, lobectomy in 6, plication in 2, and bilobectomy in 1. Complications occurred in 27 patients (43%), and 2 patients (3.0%) died. At the last follow-up, 19 had died and 44 were alive. Of the 43 patients with shortness of breath preoperatively, 29 (67.4%) were improved. Thirty patients (46.1%) had preoperative and postoperative pulmonary function tests with improvement from a median forced expiratory volume in 1 second (FEV1) of 1.0 L preoperatively to 1.4 L postoperatively (p=0.002). Increasing bulla size (p=0.02) and underlying emphysema (p=0.01) were adversely associated with postoperative morbidity. Dyspnea improved in 21 of 33 patients (64%) with underlying diffuse emphysema compared with 5 of 7 patients (71%) without emphysema (p=0.70). CONCLUSIONS: Bullectomy improved pulmonary function in most patients with a symptomatic or complicated giant bulla, or both. However, increasing bulla size and underlying emphysema resulted in increased treatment morbidity. Underlying diffuse emphysema is not a contraindication to bullectomy.
BACKGROUND: Giant bullae of the lung are rare. Little is known about functional results after surgical treatment. METHODS: This study retrospectively reviewed all patients who underwent surgical treatment for giant bullae between December 1988 and December 2010. RESULTS: There were 63 patients (51 men, 12 women) with a median age of 56 years (range, 26 to 85 years). Bullae were a median size of 14 cm (range, 9 to 30 cm). Forty-five patients (71%) had underlying diffuse emphysema. The indication for surgical intervention was symptoms alone in 30 patients (48%) and associated complications in 33 (52%). The operation was a bullectomy in 54 patients, lobectomy in 6, plication in 2, and bilobectomy in 1. Complications occurred in 27 patients (43%), and 2 patients (3.0%) died. At the last follow-up, 19 had died and 44 were alive. Of the 43 patients with shortness of breath preoperatively, 29 (67.4%) were improved. Thirty patients (46.1%) had preoperative and postoperative pulmonary function tests with improvement from a median forced expiratory volume in 1 second (FEV1) of 1.0 L preoperatively to 1.4 L postoperatively (p=0.002). Increasing bulla size (p=0.02) and underlying emphysema (p=0.01) were adversely associated with postoperative morbidity. Dyspnea improved in 21 of 33 patients (64%) with underlying diffuse emphysema compared with 5 of 7 patients (71%) without emphysema (p=0.70). CONCLUSIONS: Bullectomy improved pulmonary function in most patients with a symptomatic or complicated giant bulla, or both. However, increasing bulla size and underlying emphysema resulted in increased treatment morbidity. Underlying diffuse emphysema is not a contraindication to bullectomy.