Computed Tomographic Assessment of the Surgical Risks Associated with Fibrocavernous Pulmonary Tuberculosis

Wu, Ming; Chang, Jia‐Wei; Haung, Tsung Mao; Cheng, Li; Tseng, Yau‐Lin; Mu, Liangshan; Lai, Wu‐Wei

doi:10.1007/s00595-003-2692-2

Cited by 8 publications

(3 citation statements)

References 9 publications

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“…We previously reported that the presence of severe pleural adhesion and multiple cavities significantly increased the surgical risk during pulmonary resection for pulmonary TB. 27 , 28 Some factors indeed hinder VATS anatomic resection for pulmonary TB. The presence of a chronically thickened cavity wall with obliterated pleural space in a destroyed lung should be treated with cavernostomy and thoracoplasty or cavernostomy with intrathoracic muscle flap transposition instead of VATS.…”

Section: Discussionmentioning

confidence: 99%

The Role of Video-Assisted Thoracoscopic Therapeutic Resection for Medically Failed Pulmonary Tuberculosis

et al. 2016

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There are few reports regarding video-assisted thoracoscopic therapeutic resection for medically failed pulmonary tuberculosis (TB). We reviewed our surgical results of video-assisted thoracoscopic surgery (VATS) therapeutic resection for pulmonary TB with medical failure, and its correlation with image characteristics on chest computed tomography (CT) scan.Between January 2007 and December 2012, among the 203 patients who had surgery for TB, the medical records of 89 patients undergoing therapeutic resection for medically failed pulmonary TB were reviewed. Clinical information and the image characteristics of CT scan were investigated and analyzed.Forty-six of the 89 patients undergoing successful VATS therapeutic resection had significantly lower grading in pleural thickening (P < 0.001), peribronchial lymph node calcification (P < 0.001), tuberculoma (P = 0.015), cavity (P = 0.006), and aspergilloma (P = 0.038); they had less operative blood loss (171.0 ± 218.7 vs 542.8 ± 622.8 mL; P < 0.001) and shorter hospital stay (5.2 ± 2.2 vs 15.6 ± 15.6 days; P < 0.001). They also had a lower percentage of anatomic resection (73.9% vs 93.0%; P = 0.016), a higher percentage of sublobar resection (56.5% vs 32.6%; P = 0.023), and a lower disease relapse rate (4.3% vs 23.3%; P = 0.009). Eighteen of the 38 patients with multi-drug resistant pulmonary tuberculosis (MDRTB) who successfully underwent VATS had significantly lower grading in pleural thickening (P = 0.001), peribronchial lymph node calcification (P = 0.019), and cavity (P = 0.017). They were preoperatively medicated for a shorter period of time (221.6 ± 90.8 vs 596.1 ± 432.5 days; P = 0.001), and had more sublobar resection (44.4% vs 10%), less blood loss (165.3 ± 148.3 vs 468.0 ± 439.9 mL; P = 0.009), and shorter hospital stay (5.4 ± 2.6 vs 11.8 ± 6.9 days; P = 0.001).Without multiple cavities, peribronchial lymph node calcification, and extensive pleural thickening, VATS therapeutic resection could be safely performed in selected patients with medically failed pulmonary TB as an effective adjunct with satisfactory results.

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Section: Discussionmentioning

confidence: 99%

The Role of Video-Assisted Thoracoscopic Therapeutic Resection for Medically Failed Pulmonary Tuberculosis

et al. 2016

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“…The presence of a chronically thickened cavity wall with obliterated pleural space in a damaged lung should be treated with cavernostomy and thoracoplasty or cavernostomy with intrathoracic muscle flap transposition instead of VATS [ 26 ]. We previously reported that the presence of severe pleural adhesion and multiple cavities significantly increased the surgical risk during pulmonary resection for pulmonary TB [ 15 , 27 ]. Notably, although a variable degree of pleural adhesion was encountered, the amount of blood loss and risk of complications significantly decreased because the dissection was facilitated by the sharp vision of the VATS system.…”

Section: Discussionmentioning

confidence: 99%

From one incision to one port: The surgical technique and the evolution of segmentectomy in patients with pulmonary tuberculosis

et al. 2018

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ObjectivesWe retrospectively reviewed the evolution of segmentectomy for pulmonary tuberculosis (TB) and the feasibility of multi- and single-incision video-assisted thoracoscopic segmentectomy.MethodsOf 348 patients undergoing surgery for TB, the medical records of 121 patients undergoing segmentectomy between January 1996 and November 2015 were reviewed. Clinical information and computed tomography (CT) image characteristics were investigated and analyzed.ResultsEighteen patients underwent direct or intended thoracotomy. Sixty-four underwent video-assisted thoracoscopic segmentectomy (VATS), including 53 multi-incision thoracoscopic segmentectomy (MITS), and 11 single-incision thoracoscopic segmentectomy (SITS). Thirty-nine were converted to thoracotomy. The intended thoracotomy group had more operative blood loss (p = 0.005) and hospital stay (p = 0.001) than the VATS group although the VATS group had higher grade of cavity (p = 0.007). The intended thoracotomy group did not differ from converted thoracotomy in operative time, blood loss, or hospital stay, and the grade of pleural thickening was higher in the converted thoracotomy group (p = 0.001). The converted thoracotomy group had more operative blood loss, hospital stay, and complication rate than the MITS group (p = 0.001, p<0.001, and p = 0.009, respectively). The MITS group had lower pleural thickening, peribronchial lymph node calcification, cavity, and tuberculoma grading than the converted thoracotomy group (p<0.001, p = 0.001, 0.001, and 0.017, respectively). The SITS group had lower grading in pleural thickening, peribronchial lymph node calcification, and aspergilloma grading than the converted thoracotomy group (p = 0.002, 0.010, and 0.031, respectively). Four patients in the intended thoracotomy group and seven in the converted thoracotomy group had complications compared with three patients in the MITS and two in the SITS group. Risk factors of conversion were pleural thickening and peribronchial lymph node calcification.ConclusionAlthough segmentectomy is technically challenging in patients with pulmonary TB, it could be safely performed using MITS or SITS and should be attempted in selected patients. Its efficacy for medical treatment failure needs investigation.

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“…This is to ensure that there is a reasonable chance of complete surgical clearance of the most diseased lung parenchyma. On the other hand, it has been reported that the morbidity of surgery is associated with the anatomic extent of disease as suggested by preoperative CT 45 . The selection of patients for surgery should therefore also take into account the predicted extent of resection based on radiological findings.…”

Section: Surgical Lung Resection For Pulmonary Tbmentioning

confidence: 99%

The current role of thoracic surgery in tuberculosis management

2009

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Although tuberculosis is mainly managed medically today, thoracic surgery continues to play a key role in its diagnosis and treatment in selected subgroups of patients. In certain scenarios such as multi-drugresistant tuberculosis, advanced tuberculous empyema and symptomatic bronchial stenosis, modern thoracic surgery may represent the only effective means of management in selected patients. Advances in thoracic surgery in recent years, in particular the use of Video-Assisted Thoracic Surgery, not only reduce postoperative morbidity for individual patients, but may potentially allow a wider range of tuberculosis patients to benefit from surgery. Respiratory physicians and thoracic surgeons should continue to work together to ensure that tuberculosis patients who may benefit from surgery are identified for prompt and effective intervention.

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Computed Tomographic Assessment of the Surgical Risks Associated with Fibrocavernous Pulmonary Tuberculosis

Cited by 8 publications

References 9 publications

The Role of Video-Assisted Thoracoscopic Therapeutic Resection for Medically Failed Pulmonary Tuberculosis

The Role of Video-Assisted Thoracoscopic Therapeutic Resection for Medically Failed Pulmonary Tuberculosis

From one incision to one port: The surgical technique and the evolution of segmentectomy in patients with pulmonary tuberculosis

The current role of thoracic surgery in tuberculosis management

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