Original articleGeneral thoracicRisk Factors That Affect the Surgical Outcome in the Management of Focal Bronchiectasis in a Developed Country
Section snippets
Patients and Methods
This study was approved, with a waiver for patient consent, by the Institutional Review Board on Human Research at Fukujuji Hospital.
We retrospectively reviewed the records of 31 patients who underwent 33 anatomic lung resections for the treatment of focal bronchiectasis between 1991 and 2009 at Fukujuji Hospital in Tokyo. The patients' clinical backgrounds and symptoms are shown in Table 1. Concomitant diseases were confirmed in 8 patients (26%), and included sinusitis-rhinitis in 4 patients,
Results
As a result of preoperative assessment, bacteria were proven preoperatively in 28 patients (90%), as shown in Table 2. According to the preoperative chest CT scan, the mean number of segments involved with bronchiectasis (the preoperative extent of bronchiectatic lesion) was 3.8, and fewer than 3 segments were affected in 14 of 31 patients (45%). Bronchiectasis was bilateral in 9 patients (29%), and either the right middle lobe or the left lingular segment was involved in 29 (94%). Thirteen
Comment
Surgical treatment for focal bronchiectasis has a long history since the first report by Heidenhain [3]. Resectional surgery had served as the main effective solution for this disease until modern antibiotics and immunization became available. Since most of the extrinsic factors that cause this disease have been eradicated by modern medicine, this entity came to be considered as an “orphan disease” [7]. However, the global incidence of bronchiectasis continues to increase [8, 9, 10]. The
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2014, International Journal of SurgeryCitation Excerpt :Univariate analysis results showed that age, sputum volume, Gram-negative bacillus infection and bronchial stump coverage were related with the outcome and prognosis. Miyako Hiramatsu et al. showed that an immunocompromised status, P. aeruginosa infection, and the extent of residual bronchiectasis were significantly related with the shorter relapse-free interval by univariate analysis [8]. Age was one of the factors that affected the complications after operation, which was consistent with the previous result [13].
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2012, Thoracic Surgery ClinicsResults of Surgery for Bronchiectasis and Pulmonary Abscesses
2012, Thoracic Surgery ClinicsCitation Excerpt :Shorter hospital stay, fewer complications, and equally good symptom improvement rates were also reported. It may be ideal for selected single-stage bilateral resections, as it is better tolerated owing to less chest wall injury and better preservation of postoperative lung function.9 At the present time, VATS should probably be suitable for localized bronchiectasis with minimal scarring and absence of calcified nodes in the proximity of major vessels; however, with ongoing experience its role may expand to more challenging cases.13,25,33,52 Dense vascular chest wall and hilar adhesions need to be carefully and meticulously taken down with cautery.
Invited commentary
2012, Annals of Thoracic Surgery