Surgical intervention for pulmonary tuberculosis:: analysis of indications and perioperative data relating to diagnostic and therapeutic resections

Objective: To analyze the data on patients operated on for pulmonary tuberculosis (TB) with (Group I) or without (Group II) a correct TB diagnosis and preoperative anti-TB treatment. Methods: Between 1980 and 1997. 144 resections for TB (Groups I + II) were performed. The 80 patients in Group I underwent therapeutic resections: 32 cases involved recurrent cavities or tuberculomas. three involved post-TB bronchiectasis. 13 involved progression of cavities or tuberculomas. and 32 involved persistent tuberculomas after 6 months of anti-TB therapy. The 64 patients in Group II were operated on for a suspicion of malignancy in 49 cases, for cavitary lesions with haemophthysis in six cases. for multiple lesions in seven cases. and for recurrent hydrothorax in two cases. Results: Groups I and II included 0 and five pneumonectomies. 32 and 29 lobectomies. 48 and 20 wedge resections, 0 and nine videothoracoscopic biopsies, and 0 and one hilar lymphadenectomy. respectively. In Groups I and II, the mean duration of postoperative hospitalization was 13.2 and 10.4 days, and the frequency of postoperative pneurnothorax was 11.25 and 4.6%, respectively. The incidence of bronchopleural fistula was 1.25 and 0%, the mortality was 0 and 3.1%. and the morbidity was 53.7 and 35.9% in Groups I and II. respectively. Two patients with active disease died in Group II. Pathology demonstrated that the frequency of acid-fast bacilli in Groups I and II was 40 and 25%,. respectively. Conclusions: Patients without a correct preoperative TB diagnosis underwent more extensive parenchyma resection. Postoperative complications increased when acid-fast bacilli were present. The lack of preoperative anti-TB treatment did not involve a higher risk of minor complications, but death occurred only in this group. (C) 2001 Elsevier Science B.V. All rights reserved.