Pneumonectomy in pulmonary tuberculosis—to do or not to do?

Igor Yakovlevich Motus, Alexander Victorovich Bazhenov


Background: Pneumonectomy (PE) in pulmonary tuberculosis (PTB) and aspergillosis has to be performed in cases with multiple lung cavities or destroyed lung mainly in patients infected by drug resistant microorganisms. All that resulted in a high risk of the surgery. The aim of the study is to analyze our own experience and review the available literature on this issue.
Methods: The data of 64 patients subjected to PE during last 10 years is presented. Male/female ratio is 36/28. Average age is 44.7 years. Multi-drug resistance (MDR) and extensively drug resistance (XDR) was in 40 and in 20 patients respectively. Right PE was performed in 30 patients and left in 34. Bronchial stump was closed by stapling and by manual suturing in 25 ones, and in 39 patients respectively. Individual chemotherapy according to drug susceptibility test results was conducted before and after the operation.
Results: Overall complication rate was 31.3% including bronchopleural fistulas (BPF) rate 14.1%. Hospital mortality rate was 6.2%. All patients with postoperative had mycobacteria tuberculosis (MBT) in their sputum specimens before the operation (P<0.05). Sputum culture conversion was achieved in all 61 patients who survived the operation. Ten patients are still under therapy according to the treatment protocols. Ten (16.4%) patients relapsed, with MBT expectoration, and they are also under treatment. Five of them died from the disease. All cases of relapses were resulted from the treatment regimen violating. Forty-one (67.2%) patients remain free of the disease including those passed through postoperative complications.
Conclusions: Our experience and data available in the literature show that PE in PTB and aspergillosis can be performed with acceptable results. It should be emphasized that in these groups of patients this operation remains the only chance to be cured.