Surgery for bronchiectasis-destroyed lung: feasibility of video-assisted thoracoscopic surgery, and surgical outcomes

Abstract

Abstract OBJECTIVES To provide the experience of surgical treatment for bronchiectasis-destroyed lung and evaluate the feasibility of video-assisted thoracoscopic surgery. METHODS Bronchiectasis-destroyed lung patients underwent surgical treatment between January 2013 and June 2018 were included. Logistic regression was performed to assess factors for major complications, and Cox’s regression was performed to assess factors affected symptomatic outcome. RESULTS Totally 143 patients were treated by video-assisted thoracoscopic surgery (n = 64) and thoracotomy (n = 79). Nine (14.1%) cases scheduled for video-assisted thoracoscopic surgery were converted to thoracotomy for dense adhesions (n = 6) and frozen hilum (n = 3). The video-assisted thoracoscopic surgery group had a median chest tube duration, hospitalization, and a time of returning to full activity of 4 days, 5 days, and 1.5 months, respectively. Major complications occurred in 28 (19.6%) of all patients, 50.0% after pneumonectomy and 13.4% after lobectomy/extensive lobectomy. Multivariable analysis identified pneumonectomy (odds ratio [OR], 3.64; 95% confidence interval [CI], 1.18–11.21) as a significant predictor for major complications. Overall, 141 (98.6%) patients benefited from surgery (completely asymptomatic, n = 109; acceptable alleviation, n = 32). Thirty-four patients experienced relapse of the disease, including 13 with productive cough, 11 with haemoptysis, and 10 with recurrent infections. Pseudomonas aeruginosa infection (hazard ratio [HR], 3.07; 95% CI, 1.38–6.83) and extent of remanent bronchiectatic areas (HR, 1.03; 95% CI, 1.00–1.05) were independent risk factors for shorter relapse free interval. CONCLUSIONS Video-assisted thoracoscopic surgery for bronchiectasis-destroyed lung is feasible in well-selected patients. Pneumonectomy increased the risk of postoperative major complications. Removing all bronchiectasis-destroyed lung lesions contributed to satisfactory prognosis.