Clinical Outcomes of Pulmonary Resections for Benign Lung Diseases in Adults: Pulmonary Resections for Benign Lung Diseases in Adults

Muhammad  Shoaib Lodro; Tanveer  Ahmad; Misauq  Mazcuri; Ambreen  Abid; Nadir  Ali

doi:10.54393/pjhs.v3i04.94

Authors

Muhammad Shoaib Lodro Department of Thoracic surgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
Tanveer Ahmad Department of Thoracic surgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
Misauq Mazcuri Department of Thoracic surgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
Ambreen Abid Department of Thoracic surgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
Nadir Ali Department of Thoracic surgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v3i04.94

Keywords:

Lobectomy, Benign Lung Disease, Pulmonary/Lung Resection, Complications, Bronchiectasis, Aspergilloma

Abstract

Benign lung diseases (BLD) are a spectrum of diseases that require medical and surgical attention. Surgical treatment in majority cases provides curative treatment in majority of the cases. Objective: To assess the clinical outcome in patients who undergo pulmonary resection for various indications in BLD. Methods: A prospective study was conducted in The Department of Thoracic surgery at Jinnah Postgraduate Medical Center, Karachi from June 2021 to June 2022. All symptomatic patients above the age of 12 years with radiological evidence of resectable lung disease with good cardiopulmonary reserve were included. Results: Eighty-four patients were included; sixty-six (78.6%) were males. Most common indication for resection was bronchiectasis (n=32; 38.1%) and aspergilloma (n=22; 26.2%). Majority of the patients presented with productive cough (44; 52.3%), chest pain (41; 48.8%) and hemoptysis (28;33%). Eighteen (81.8%) out of 22 patients of aspergilloma were complex in nature. Lobectomy (67; 78.8%) was most commonly performed followed by wedge resection (10; 11.7%). Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) both were significantly improved after lung resection (p˂0.001). The most common complications were post resection fluid (n=12; 14.2%), residual pleural space (n=10;11.9%). Three patients (3.6%) died; two (2.38%) due to respiratory failure and one (1.2%) after myocardial infraction. Conclusions: Despite limitations, lobectomy and lesser pulmonary resections are safe procedures when patients are carefully selected and prepared. Management in a dedicated Thoracic Surgical unit is essential to keep the complication rate under control and patients should be assessed for symptomatic (spirometric) and radiological improvement on follow up visits to document ongoing clinical improvement for an improved quality of life

References

Gülhan SŞE, Acar LN, Sayılır Güven E, Bıçakçıoğlu P, Aydın E, Karasu S, et al. Surgical treatment of bronchiectasis: Our 23 years of experience. Turk Gogus Kalp Damar Cerrahisi Derg. 2020 Oct; 28(4):629-637. doi: 10.5606/tgkdc.dergisi.2020.19389.

Myrdal G, Gustafsson G, Lambe M, Horte LG, Stahle E. Outcome after lung cancer surgery. Factors predicting early mortality and major morbidity. European Journal of Cardio-Thoracic Surgery 2001; 20: 694–699. doi: 10.1016/s1010-7940(01)00875-2.

Brunelli A. Risk Assessment for Pulmonary Resection. Seminars in Thoracic and Cardiovascular Surgery. 2010; 22(1):2-13. doi: 10.1053/j.semtcvs.2010.04.002.

Augustin F, Maier HT, Weissenbacher A, Ng C, Lucciarini P, Öfner D, et al. Causes, predictors and consequences of conversion from VATS to open lung lobectomy. Surgical Endoscopy. 2016 Jun; 30(6):2415-21. doi: 10.1007/s00464-015-4492-3.

Reichert M, Kerber S, Pösentrup B, Bender J, Schneck E, Augustin F, et al. Anatomic lung resections for benign pulmonary diseases by video-assisted thoracoscopic surgery (VATS). Langenbeck's Archives of Surgery 2016 Sep; 401(6):867-75. doi: 10.1007/s00423-016-1478-0.

Agasthian T. Results of surgery for bronchiectasis and pulmonary abscesses. Thoracic Surgery Clinics. 2012 Aug; 22(3):333-44. 10.1016/j.thorsurg.2012.04.008.

Conlan A, Lukanich J, Shutz J, Hurwitz S. Elective pneumonectomy for benign lung disease: Modern-day mortality and morbidity. The Journal of Thoracic and Cardiovascular Surgery. 1995 Oct; 110(4): 1118-1124.doi: 10.1016/s0022-5223(05)80181-3.

McGovern E, Trastek V, Pairolero P, Payne W. Completion Pneumonectomy: Indications, Complications, and Results. The Annals of Thoracic Surgery. 1988 Aug; 46(2):141-146. doi: 10.1016/s0003-4975(10)65886-9.

Owen R, Force S, Pickens A, Mansour K, Miller D, Fernandez F. Pneumonectomy for benign disease: analysis of the early and late outcomes. European Journal of Cardio-Thoracic Surgery. 2012 Feb; 43(2):312-317. doi: 10.1093/ejcts/ezs284.

Shapiro M, Swanson S, Wright C, Chin C, Sheng S, Wisnivesky J et al. Predictors of Major Morbidity and Mortality After Pneumonectomy Utilizing The Society for Thoracic Surgeons General Thoracic Surgery Database. The Annals of Thoracic Surgery. 2010 Sep; 90(3):927-935. doi: 10.1016/j.athoracsur.2010.05.041.

Coutinho D, Fernandes P, Guerra M, Miranda J, Vouga L. Surgical treatment of bronchiectasis: A review of 20 years of experience. journal of the Portuguese Society of Pulmonology 2016 Apr; 22(2):82-5. doi: 10.1016/j.rppnen.2015.09.007.

Yun JS, Song SY, Na KJ, Kim S, Jang KH, Jeong IS, et al. Surgery for hemoptysis in patients with benign lung disease. Journal of thoracic disease 2018; 10(6): 3532-3538.doi: 10.21037/jtd.2018.05.122

Nega B, Ademe Y, Tizazu A. Bronchiectasis: Experience of Surgical Management at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Ethiopian journal of health sciences 2019 Jul; 29(4):471-476. doi: 10.4314/ejhs. v29i4.8.

Zhang P, Jiang G, Ding J, Zhou X, Gao W. Surgical treatment of bronchiectasis: a retrospective analysis of 790 patients. The Annals of Thoracic Surgery. 2010 Jul; 90:246–250. doi: 10.1016/j.athoracsur.2010.03.064.

Setianingrum F, Rautemaa-Richardson R, Shah R, Denning DW. Clinical outcomes of patients with chronic pulmonary aspergillosis managed surgically. European Journal of Cardio-Thoracic Surgery. 2020; 58(5):997-1003. doi: 10.1093/ejcts/ezaa137

Alemu BN. Surgical Outcome of Chronic Pulmonary Aspergilloma: An Experience from Two Tertiary Referral Hospitals in Addis Ababa, Ethiopia. Ethiopian Journal of Health Sciences. 2020 Jul; 30(4): 521-530. doi: 10.4314/ejhs. v30i4.7.

Dogru M, Sezen C, Aker C, Erdogu V, Erduhan S, Cansever L et al. Evaluating Giant Hydatid Cysts: Factors Affecting Mortality and Morbidity. Annals of Thoracic and Cardiovascular Surgery. 2021 Jun; 27(3):164-168. doi: 10.5761/atcs.oa.20-00178

Aiolfi A, Inaba K, Martin M, Matsushima K, Bonitta G, Bona D, et al. Lung Resection for Trauma: A Propensity Score Adjusted Analysis Comparing Wedge Resection, Lobectomy, and Pneumonectomy. The American Journal of Surgery. 2020 Mar; 86(3):261-265.

Lesser T. Die pleurale Residualhöhle nach Lungenresektion [Residual Pleural Space after Lung Resection]. Zentralblatt für Chirurgie 2019 Sep; 144(S 01): S31-S42. German. doi: 10.1055/a-0896-8748.

Clark JM, Cooke DT, Brown LM. Management of Complications After Lung Resection: Prolonged Air Leak and Bronchopleural Fistula. Thoracic Surgery Clinics 2020 Aug; 30(3):347-358. doi: 10.1016/j.thorsurg.2020.04.008.

Gu Z, Wang H, Mao T, Ji C, Xiang Y, Zhu Y et al. Pulmonary function changes after different extent of pulmonary resection under video-assisted thoracic surgery. Journal of Thoracic Disease. 2018 April; 10(4):2331-2337. doi: 10.21037/jtd.2018.03.163.

Taylor LJ, Julliard WA, Maloney JD. Predictive value of pulmonary function measures for short-term outcomes following lung resection: analysis of a single high-volume institution. Journal of Thoracic Disease. 2018 Feb; 10(2):1072-1076. doi: 10.21037/jtd.2018.01.100.

Zhang R, Lee S, Wigfield C, Vigneswaran W, Ferguson M. Lung Function Predicts Pulmonary Complications Regardless of the Surgical Approach. The Annals of Thoracic Surgery. 2015 May; 99(5):1761-1767. doi: 10.1016/j.athoracsur.2015.01.030.

Ferguson MK, Watson S, Johnson E, Vigneswaran WT. Predicted postoperative lung function is associated with all-cause long-term mortality after major lung resection for cancer. European Journal of Cardio-Thoracic Surgery. 2014 April; 45(4): 660-4.doi: 10.1093/ejcts/ezt462

Bilal A. Pneumonectomy for Benign Lung Disease: Peshawar Experience of 1053 Cases. Heart, Lung and Circulation. 2018 Jan; 27: S504-S505. doi: 10.1016/j.hlc.2018.04.012