Role of Anti-Tuberculous Treatment in the Outcome of Decortication for Chronic Tuberculous Empyema

Abstract

Introduction: Chronic tuberculous empyema (CTE) is a common complication of tuberculosis that requires some form of surgical intervention along with anti-tuberculosis therapy (ATT). The aim of this study was to determine the optimum duration of pre-operative ATT in CTE prior to the decortication and its outcomes. Material and Methods: This comparative prospective study was conducted from August 2019 to August 2020 in the Department of Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan. A total of 70 patients were included in the study. They were grouped into two arms: patients operated at or within six weeks of ATT commencement (Group A) and patients operated after six weeks of ATT (Group B). Both groups had 35 participants each. Patients were evaluated based on a self-administered questionnaire. A p-value of less than 0.05 was considered significant. Result: In this study, there were 55 (78.6%) males and 15 (21.4%) females with a mean age of 33.5 ± 11.2 years. Diagnosis of CTE was most commonly made through sputum acid-fast bacilli (AFB) smear (n=35, 50%) which most commonly involved right upper (n=20, 28.6%) and lower lung lobes (n=20, 28.6%). Complications such as air leaks, need for ventilator support, need for intensive care unit (ICU) stay, residual collection, and pneumothorax all were significantly higher in Group A (31 patients out of 35) compared to Group B (18 patients out of 35). In Group B, 21 (60%) participants had full post-operative expansion of lungs, compared to eight (22.8%) in Group A (p=0.002). In total five participants had failure to expand lungs; all of them belonged to Group A (p=0.02). Conclusion: The optimum timing of surgery and preoperative ATT is crucial for achieving better outcomes and requires good collaboration between the treating pulmonologist and thoracic surgeon. Our study highlights the importance of pre-operative ATT for at least more than six weeks before undertaking decortication for better outcomes and minimizing morbidity.

Successful surgical treatment of bronchopleural fistula caused by severe pulmonary tuberculosis: A case report and review of literature

“…Clinical treatment of tuberculous BPF complicated with multiple infections is a huge challenge. We believe that preoperative standard anti-tuberculosis treatment combined with full thoracic drainage is crucial[ 13 , 14 ]. For patients with Mycobacterium tuberculosis-positive sputum before surgery, a drug-resistant tuberculosis test is needed to choose effective anti-tuberculosis drugs.…”

Open decortication for patients presenting with stage III tuberculous empyema with low density lines on CT imaging

“…The optimum timing of surgery is crucial for achieving better outcomes. Nazish Sikander’s group emphasized that preoperative anti-tuberculosis therapy for at least six weeks may yield better outcomes and minimize morbidity 12 . However, some studies have reported a range of two weeks to 12 months of preoperative anti-tuberculous treatment before decortication surgery 13 .…”

“…However, some studies have reported a range of two weeks to 12 months of preoperative anti-tuberculous treatment before decortication surgery 13 . Despite numerous studies, there are still considerable differences in the timing of surgery for stage III tuberculous empyema, and it remains controversial 12 . Even if the patients all suffer from chronic tuberculous empyema, their pathological manifestations are inconsistent, making it challenging to determine the optimal operation time by relying only on the preoperative anti-tuberculosis time and the course of disease.…”

The efficacy and safety of uniportal video-assisted thoracic surgery on the treatment for stage II-III tuberculous empyema: a single-arm clinical retrospective study from 2016 to 2021 in a thoracic surgery center in China

“…Incomplete lung reexpansion was defined as lung collapse on CT image with or without cardiac or costophrenic angle passivation/ effusion. Failure of lung re-expansion is characterized by no change in postoperative CT compared with preoperative CT [15].…”