Korean J Thorac Cardiovasc Surg.  2012 Apr;45(2):110-115. 10.5090/kjtcs.2012.45.2.110.

Early and Long-term Outcomes of Pneumonectomy for Treating Sequelae of Pulmonary Tuberculosis

• Byun CS
• Chung KY
• Narm KS
• Lee JG
• Hong D
• Lee CY

• KMID: 1433672
• DOI: http://doi.org/10.5090/kjtcs.2012.45.2.110

Abstract

BACKGROUND
Pneumonectomy remains the ultimate curative treatment modality for destroyed lung caused by tuberculosis despite multiple risks involved in the procedure. We retrospectively evaluated patients who underwent pneumonectomy for treatment of sequelae of pulmonary tuberculosis to determine the risk factors of early and long-term outcomes.
MATERIALS AND METHODS
Between January 1980 and December 2008, pneumonectomy or pleuropneumonectomy was performed in 73 consecutive patients with destroyed lung caused by tuberculosis. There were 48 patients with empyema (12 with bronchopleural fistula [BPF]), 11 with aspergilloma and 7 with multidrug resistant tuberculosis.
RESULTS
There were 5 operative mortalities (6.8%). One patient had intraoperative uncontrolled arrhythmia, one had a postoperative cardiac arrest, and three had postoperative respiratory failure. A total of 29 patients (39.7%) suffered from postoperative complications. Twelve patients (16.7%) were found to have postpneumonectomy empyema (PPE), 4 patients had wound infections (5.6%), and 7 patients required re-exploration due to postoperative bleeding (9.7%). The prevalence of PPE increased in patients with preoperative empyema (p=0.019). There were five patients with postoperative BPF, four of which occurred in right-side operation. The only risk factor for BPF was the right-side operation (p=0.023). The 5- and 10-year survival rates were 88.9% and 76.2%, respectively. The risk factors for late deaths were old age (> or =50 years, p=0.02) and low predicted postoperative forced expiratory volume in one second (FEV1) (<1.2 L, p=0.02).
CONCLUSION
Although PPE increases in patients with preoperative empyema and postoperative BPF increases in right-side operation, the mortality rates and long-term survival rates were found to be satisfactory. However, the follow-up care for patients with low predicted postoperative FEV1 should continue for prevention and early detection of pulmonary complication related to impaired pulmonary function.

Keyword

Tuberculosis; Pneumonectomy; Bronchopleural fistula; Empyema; Lung function

MeSH Terms

Arrhythmias, Cardiac
Empyema
Fistula
Follow-Up Studies
Forced Expiratory Volume
Heart Arrest
Hemorrhage
Humans
Lung
Pneumonectomy
Postoperative Complications
Prevalence
Respiratory Insufficiency
Retrospective Studies
Risk Factors
Survival Rate
Tuberculosis
Tuberculosis, Pulmonary
Wound Infection