A retrospective review comparing the treatment outcomes of emergency lung resection for massive haemoptysis with and without preoperative bronchial artery embolization

The objective of this review was to determine the feasibility of emergency lung resection for massive haemoptysis without preoperative bronchial artery embolization (BAE). The potential for fatal recurrent haemoptysis following BAE may be avoided if surgery is undertaken instead. Furthermore, if the outcomes for emergency lung resection with and without BAE are equivalent, it may be advisable to bypass BAE and proceed directly to resection. A retrospective review of case records from January 2005 to October 2007 of patients admitted to the Department of Cardiothoracic Surgery with massive haemoptysis deemed suitable for emergency lung resection was undertaken. Following urgent clinical evaluation, emergency lung resection with or without preoperative BAE was undertaken. If BAE was selected, the timing of lung resection was dependent upon the presence of recurrent haemoptysis. Sixty-one patients with massive haemoptysis were deemed suitable for emergency lung resection. Forty-one patients had lung resection without BAE. One patient (2%) had recurrent minor haemoptysis after surgery. Other complications included 2 deaths, 1 post-resection empyema thoracis and 1 deep thoracotomy wound infection. Twenty patients underwent surgery following BAE. Fifteen (75%) patients had recurrent haemoptysis after BAE. None developed recurrent haemoptysis after surgery. Other complications included 1 death and 2 post-resection empyema thoraces. This retrospective study suggests that emergency lung resection is feasible in appropriately selected patients presenting with radiologically localized disease and massive haemoptysis. These data also suggest that BAE is probably best utilized as a temporizing measure in patients unsuitable for emergency lung resection.