The Efficacy and Safety of Surgical Treatment for Patients With Tuberculosis Destroyed Lung With or Without Chronic Pulmonary Aspergillosis

Ruan, Hongyun; Gong, Changfan; Wang, Jinxiang

doi:10.1007/s00268-021-05969-w

Cited by 13 publications

(13 citation statements)

References 34 publications

(53 reference statements)

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“…In Asia and Africa, 15.4% of TB cases are coinfected with Aspergillus or non-tuberculous mycobacteria, with Aspergillus coinfection significantly increasing risk of death [ 1 ] . In addition, our recent study demonstrated that TDL accompanied by chronic pulmonary aspergillosis was associated with an increase in number of serious postoperative complications in men [ 15 ]. Therefore, short- and long-term risks and benefits of surgery for men, especially those with pulmonary aspergillosis and/or non-pulmonary mycobacterial infection, need to be carefully evaluated.…”

Section: Discussionmentioning

confidence: 99%

Long-term follow-up of tuberculosis-destroyed lung patients after surgical treatment

Ruan

Liu

et al. 2022

BMC Pulm Med

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Background To monitor dypsnea and mortality at 5 and 10 years, respectively, after surgical treatment of tuberculosis-destroyed lung (TDL) patients. Methods TDL patients treated surgically at Beijing Chest Hospital from November 2007 to June 2019 were monitored in this observational study. Follow-up assessments of respiratory function indicators and survival conducted 5 and 10 years post-surgery led to patient grouping based on mMRC score into a dyspnea group (mMRC ≥ 1) and a non-dyspnea group (mMRC = 0). Cox regression analysis detected effects of patient demographics, clinical characteristics, surgical factors and respiratory function on 5 year post-surgical survival. Results By study completion (June 30, 2020), 32 of 104 patients were lost and 72 completed follow-up for a study total of 258.9 person-years. 45 patients (62.5%, 45/72) had mMRC scores of 0, while 12 (16.7%, 12/72), 21 (36.2%, 21/58) and 27 (60.0%, 27/45) patients exhibited dyspnea by 1, 3 and 5 years post-surgery, respectively. Low lung carbon monoxide diffusion score (DLCO% pred) and scoliosis contributed to dyspnea occurrence. Conclusions Most TDL patients lacked subjective dyspnea signs post-surgery, while dyspnea rates increased with time. Preoperative low lung diffusion function and Scoliosis were associated with factors for postoperative dyspnea. Surgical treatment increased TDL patient survival overall.

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Section: Discussionmentioning

confidence: 99%

Long-term follow-up of tuberculosis-destroyed lung patients after surgical treatment

Ruan

Liu

et al. 2022

BMC Pulm Med

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“…Continuous antifungal therapy is usually required to delay disease progression or alleviate symptoms. Surgical outcomes are uncertain, and there are only a few reports on the surgical treatment of CFPA [ 19 – 21 ], which may be because of the high postoperative complication rate and mortality. 13 patients accepted surgery in the present study, and 5 (38.5%) suffered postoperative complications, 1 relapsed.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of surgery for different types of chronic pulmonary aspergillosis: results from a single-center, retrospective cohort study

Chang-ming

Qiao²,

Wang³

et al. 2022

BMC Pulm Med

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Background The reported experience of surgical treatment for chronic pulmonary aspergillosis (CPA) mainly focused on simple aspergilloma (SA), few about other types of CPA. The present study aims to evaluate the outcomes of surgical treatment for different types of CPA. Methods We performed a retrospective analysis of 85 patients with CPA who underwent surgery from 2014 to 2020 at Shandong Provincial Chest Hospital. The patients were divided into four types, including SA, chronic cavitary pulmonary aspergillosis (CCPA), chronic fibrosing pulmonary aspergillosis (CFPA), aspergillus nodule (AN). We collected and analyzed the preoperative, perioperative, and postoperative data to evaluate the outcomes of surgical treatment of different types of CPA. Results The four groups had similar age (p = 0.22), symptoms (p = 0.36), lesion location (p = 0.09), VATS rate (p = 0.08), recurrence rate (p = 0.95), and had significant difference in surgical procedures (p < 0.01), time of surgery (p < 0.01), intraoperative blood loss (p < 0.01), postoperative complication (p = 0.01). CFPA (P = 0.01), longer surgical time (P = 0.001), and more intraoperative blood loss (P = 0.004) were risk factors of postoperative complication, more intraoperative blood loss (> 400 ml) was the independent risk factor (OR 13.5, 95% CI 1.6–112.1, P = 0.02). 6 patients relapsed after surgery with a recurrence rate of 7.1%. The mean time to relapse was 14.8 months (2–30 months) after surgery. Relapse occurred in 2 SA patients, 3 CCPA, and 1 CFPA, respectively, while none of the AN patients relapsed. No risk factor for recurrence was found. Conclusions Surgical resection seems safe and effective in the treatment of SA, AN, CCPA with a low complication and recurrence rate, while surgery for CFPA should be limited to selected patients because of its higher complication rate.

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“…In addition, we found a strong association between underlying aspergillus and NTM infections and postoperative complications. Despite typical radiologic findings of pulmonary TB and aspergillus or NTM [ 13 , 19 ], it is difficult to diagnose these diseases when they coexist in the same patient. Our finding indicated that the misdiagnosis of these concurrent infections resulted in elevated risk for developing serious complications after pneumonectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical contraindications were as follows: respiratory failure in preoperative blood gas analysis; serious comorbidities; bilateral involvement of lesions. Whether or not to take surgical treatment for TDL patients was discussed and decided by a team of experts from radiology, thoracic surgery and anesthesiology [ 13 ]. The time span from chest CT diagnosis to operation was 0–120 months (median 2 months).…”

Section: Methodsmentioning

confidence: 99%

Incidence and risk factors of postoperative complications in patients with tuberculosis-destroyed lung

et al. 2021

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Background The purpose of this study was to determine risk factors of postoperative complications in tuberculosis-destroyed lung (TDL) patients. Methods We retrospectively analyzed the data from all consecutive TDL patients undergoing surgical treatment at the Beijing Chest Hospital from January 2001 to September 2019. Results Of 113 TDL cases experiencing surgery, 33 (29.2%) experienced postoperative complications. The patients with low BMI were more likely to have postoperative complications compared to those with normal BMI, whereas a significant lower rate of postoperative complications was noted in patients with BMI ≥ 25 kg/m2. In addition, significant increased risk was observed in patients with smoking history. We found that the patients with underlying infection, including aspergillus and nontuberculous mycobacteria (NTM), had significantly higher odds of having postoperative complications compared with those without underlying infection. The anaemia was another important independent factor associated with postoperative complication. Patients with blood transfusion above 1000 mL had a strongly increased frequency of postoperative complications than patients with blood transfusion below 1000 mL. Conclusion In conclusion, our data demonstrate that approximate one third of TDL patients experience postoperative complications in our cohort. Patients with low BMI, anaemia, tobacco smoking, and coinfected aspergillus or NTM are at markedly higher risk to experience postoperative complications after pneumonectomy.

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The Efficacy and Safety of Surgical Treatment for Patients With Tuberculosis Destroyed Lung With or Without Chronic Pulmonary Aspergillosis

Cited by 13 publications

References 34 publications

Long-term follow-up of tuberculosis-destroyed lung patients after surgical treatment

Long-term follow-up of tuberculosis-destroyed lung patients after surgical treatment

Outcomes of surgery for different types of chronic pulmonary aspergillosis: results from a single-center, retrospective cohort study

Incidence and risk factors of postoperative complications in patients with tuberculosis-destroyed lung

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