Original article
General thoracic
Risk Factors That Affect the Surgical Outcome in the Management of Focal Bronchiectasis in a Developed Country

https://doi.org/10.1016/j.athoracsur.2011.08.077Get rights and content

Background

The purpose of this study was to demonstrate our surgical experience for focal bronchiectasis in the setting of modern diagnostic modalities and state-of-the-art medical treatment in a developed country.

Methods

Thirty-one patients undergoing 33 lung resections for the treatment of focal bronchiectasis from 1991 to 2009 were reviewed. The mean age was 54 years. Twenty-nine patients (94%) were female; 21 patients (68%) had nontuberculous mycobacterial infection; and 22 patients (71%) received preoperative multiple-drug regimens containing clarithromycin. Five patients (16%) were in an immunocompromised status. All were diagnosed by chest computed tomography scan, and either the right middle lobe or left lingula were involved in 29 (94%). The curve for relapse-free interval was estimated by Kaplan-Meier methods. The factors that affected this curve were examined using Cox's regression analysis.

Results

Operative morbidity and mortality were 18% and 0%, respectively. All patients became asymptomatic postoperatively. During the median follow-up of 48 months (11 to 216), 8 patients (26%) experienced recurrence, and the mean relapse-free interval was 34 months (3 to 216). By univariate analysis, an immunocompromised status (p = 0.017), Pseudomonas aeruginosa infection (p = 0.040), the preoperative extent of bronchiectatic lesion (p = 0.013), and the extent of residual bronchiectasis after surgery (p = 0.003) were significantly associated with the shorter relapse-free interval. By multivariate analysis, an immunocompromised status (p = 0.039), Pseudomonas aeruginosa infection (p = 0.033), and the extent of residual bronchiectasis (p = 0.009) were independent and significant factors.

Conclusions

Complete resection of bronchiectasis while the disease is localized and is free from Pseudomonas aeruginosa infection is the key for a success. Also, immunocompromised status was suggested to be a risk factor.

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

References (33)

  • M. Nagaki et al.

    Role of chronic Pseudomonas aeruginosa infection in the development of bronchiectasis

    Chest

    (1992)
  • M.A. Martinez-Garcia et al.

    Factors associated with lung function decline in adult patients with stable on-cystic fibrosis bronchiectasis

    Chest

    (2007)
  • R.T.H. Laenec

    [Del'auscultation mediate, ou traite du diagnostic des maladies des poumons et du Coeur.]

    (1819)
  • L. Heidenhain

    [Verhandlungen der Deutschen Gesellschaft fur Chirurgie.]

    (1901)
  • D.P. Naidich et al.

    Computed tomography of bronchiectasis

    J Comput Assist Tomogr

    (1982)
  • J.D. Dodd et al.

    Conventional high-resolution CT versus helical high-resolution MDCT in the detection of bronchiectasis

    AJR Am J Roentgenol

    (2006)
  • Cited by (20)

    • Surgery for predominant lesion in nonlocalized bronchiectasis

      2017, Journal of Thoracic and Cardiovascular Surgery
    • Surgical treatment of bronchiectasis: A retrospective observational study of 260 patients

      2014, International Journal of Surgery
      Citation 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].

    • Results of Surgery for Bronchiectasis and Pulmonary Abscesses

      2012, Thoracic Surgery Clinics
      Citation 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
    View all citing articles on Scopus
    View full text