Surgery for bronchiectasis: The effect of morphological types to prognosis

Abstract

BACKGROUND:Although the incidence has declined over the past years in societies with high socioeconomic status, bronchiectasis is still an important health problem in our country.AIM:To review and present our cases undergoing surgery for bronchiectasis in the past 12 years and their early and late term postoperative outcomes and our experience in bronchiectasis surgery and the effect of morphological type on the prognosis.METHODS:The medical records of 62 cases undergoing surgical resection for bronchiectasis in the Clinics of Thoracic and Pediatric Surgery were evaluated retrospectively. The disease was on the left in 33 cases, on the right in 26 and bilateral in three cases. The most common surgical procedure was lobectomy. Forty one patients underwent pneumonectomy, lobectomy and complete resection including bilobectomy. Twenty-one (33.87%) cases underwent incomplete resection, of whom 11 (17.74%) underwent segmentectomy and 10 (16.13%) underwent lobectomy + segmentectomy.RESULTS:It was found that the rate of being asymptomatic was significantly higher in patients undergoing complete resection compared to those undergoing incomplete resection. Spirometric respiratory function tests were performed to assess the relationship between morphological type and the severity of disease. All parameters of respiratory function were worse in the saccular type and FEV1/FVC showed a worse obstructive deterioration in the saccular type compared to the tubular type.CONCLUSION:The success rate of the procedure increases with complete resection of the involved region. The morphological type is more important than the number and extension of the involved segments in showing the disease severity.

Surgical treatment of bronchiectasis: Our 23 years of experience

“…In previous studies, this ratio ranged between 64.7% and 90.7%. [ 3 , 5 , 11 - 14 , 31 , 32 ] In the patients who underwent complete resections, we found that 58.9% were asymptomatic, 33.3% showed an improvement, and 0.9% showed a deterioration, consistent with the literature. If a complete resection cannot be done due to excessive bronchiectasis and medical treatment is inadequate in life-threatening hemoptysis or infection-related complications which affect the patient"s daily routine, a palliative resection (incomplete resection) can be done by removing the areas most affected to relive the symptoms.…”

Surgery for predominant lesion in nonlocalized bronchiectasis

“…The predominant lesion could be determined reliably on preoperative CT scan because the degree of bronchiectatic radiological abnormality was associated commonly with clinical manifestation and the patient's quality of life. [24][25][26][27] Therefore, a marked symptomatic improvement and a good satisfactory outcome could be obtained in nonlocalized bronchiectatic patients after removal of the predominant lesion, as shown in our study. It is worth mentioning that the surgical benefit is limited to patients who have only one predominant area of bronchiectatic disease that can be localized by CT, instead of those with diffuse bronchiectasis (ie, cystic fibrosis).…”

Impact of Different Etiologies of Bronchiectasis on the Pulmonary Function Tests

“…25 Etiology of bronchiectasis was attributed to non-tuberculosis infection if bacterial or viral infections were well documented in the medical records. 26 The diagnosis of CF was based on at least two of the following criteria: sweat chloride concentration >60 mEq/mL, two clinical features consistent with CF, or genetic testing demonstrating two mutations associated with CF. 27 The diagnosis of PCD was made clinically and confirmed through transmission electron microscopy.…”