Results of Lobectomy and Pneumonectomy in Pulmonary TB


Department of Thoracic Surgery, NRITLD, Shaheed Beheshti University of Medical Sciences and Health Services, TEHRAN-IRAN


Background: The results of lobectomy and pneumonectomy in treating various benign and malignant lesions of lung have been reported. The complications and results of such procedures in the presence of pulmonary tuberculosis (TB) have been described in older texts. However these reports have lessened due to the decrease in the number of patients seen over the last decades. Thus, it's not clear that to what extent the advancements seen in surgical and anesthetic procedures were effective in lessening the complications of such procedures. Materials and Methods: The study group consisted of all referral patients suffering from pulmonary TB or its complications that had undergone lobectomy or pneumonectomy in Massih Daneshvari Hospital from October 1996 to September 2003 (7 years). All the necessary information and data were collected from both medical records of the patients and special questionnaires that were designed by our staff in 1996 for this purpose. Statistical analysis was carried out descriptively by using frequency and percentage. Presence of TB in the patients was confirmed by identifying the microorganism in the tissues detecting pathological changes in favour of TB and/or having past history of pulmonary TB associated with its anatomical complications such as cavitation, bronchiectasis, and bronchial stenosis. Results: A total number of 172 patients underwent surgical procedures either for diagnosis of TB or managing its complications. Lobectomy was performed in 27 patients while 7 underwent pneumonectomy. The indications for these surgical procedures were: recurrent hemoptysis (24 cases), massive hemoptysis (4 cases), multi drug resistant TB (4 cases), bronchiectasis and recurrent infection (2 cases), and right bronchial stenosis (1 case). In two of the patients the indication for surgery was intra-bronchial carcinoid tumour. Lymph node biopsies obtained during the surgery showed pathological changes of TB. The most important complications observed were severe bleeding occurring after right pneumonectomy, empyema at the site of left superior lobectomy, and stenosis at the distal part of trachea in a patient who had right bronchial stenosis and destruction of superior lobe for which sleeve lobectomy was performed. All the above-mentioned complications were managed with appropriate treatment. The only exception was the patient having distal tracheal stenosis who needed repeated dilatation. There were five deaths in this group of patients: 3 in the lobectomy group (3 deaths out of total 27 lobectomies performed i.e. 11.1%) and 2 deaths in pneumonectomy group (2 deaths in total 7 pneumonectomies performed i.e. 28.5%). The causes of death were cardiac complications (2 cases), respiratory failure (2 cases), and unknown cause (1 case). Four out of the five expired cases had undergone emergency thoracotomy despite the fact that they were placed in the high risk group for operation. Surgery in other cases was successful with the aims being reached. Also, out of 4 patients that had been treated for Multi-drug Resistant TB (MDR-TB), one became smear positive showing the relapse of the disease. Conclusion: Performing the surgical procedures of lobectomy and pneumonectomy in patients suffering from pulmonary TB is associated with good results and complications that are "tolerable". However, mortality and morbidity rates' following pneumonectomy are higher than usual cases. In these patients emergency thoracotomy results in high mortality. (Tanaffos 2003; 2(7): 33-39)