The Prognosis for the Contralateral Lung after Resection for Pulmonary Tuberculosis

Abstract

Comparatively little attention has been paid to the factors affecting the fate of the contralateral lung after resection for pulmonary tuberculosis. In particular, the previous history of the patient and his reaction to the tubercle bacillus and the radiological history of the lung, as opposed to the extent of disease at the time of the operation, have been the subject of very little analysis. The records of 101 patients who had survived the immediate post-operative period (three months) were available for study. Their fate and the condition of the contralateral lung at the end of the follow-up period are shown in Table I. In only 11 was the contralateral lung considered to be unsatisfactory. By "unsatisfactory" we mean that a deterioration had taken place during the follow-up period. Hence " satisfactory " means unchanged or improved without intermediate deterioration.Of the six patients who died after the postoperative period (three months), five had satis- Accordingly it seems that deterioration in the contralateral lung if connected with the resection will probably appear within 12 months, and hence the cases followed for the shorter times can reasonably be included with those followed for the full two years.The selection of cases by a number of physicians makes it certain that the group was widely representative both in the type of case and in the important factor of duration of the pre-operative treatment.We have tried to find out if there were any factors in the clinical or radiological history which made deterioration in the contralateral lung especially likely. We have analysed the previous radiological history of the extent of disease in the resected lung, the pre-operative amount of sputum, the length of history, and the ages and sex, with the following results.

CHAPTER 8: The Place of Surgery in the Control of Pulmonary Tuberculosis

“…Dark and Jewsbury (1953) found that, after upper or lower lobectomy, ipsilateral reactivation occurred when no measures were taken to prevent over‐distension of the remaining lobe, but not when such measures were employed. Bickford and others (1952) had 10 cases of reactivation of disease in the apex of the lower lobe following upper lobectomy without corrective thoracoplasty, but no case when lobectomy was supplemented by thoracoplasty, Geake and Young (1953) point out that over‐distension may not be as bad as might be expected, because it is more likely to influence normal than diseased lung owing to their differing distensibilities. Until this matter is settled, severe over‐distension of remaining lung should be prevented permanently.…”