Surgical Management of Bronchiectasis: A Collective Review of 339 Patients with Long-term Follow-up

Abstract

Objective: The incidence of bronchiectasis has decreased significantly in developed countries due to successful control of childhood infections. However, the surgical treatment of this disease still plays an important role in thoracic surgical practice in underdeveloped and developing countries. The aim of this retrospective study was to present our surgical experience in patients with bronchiectasis, including our surgical treatment strategies and the results of long-term follow-up. Methods: A retrospective chart review was conducted of 339 patients who underwent surgical resection for bronchiectasis between January 1992 and December 2009. The patients' demographic features, the symptoms, etiologies and resection types, morbidity, mortality and outcomes after surgical management were analyzed. Results: There were 301 (88.8 %) male and 38 (11.2 %) female patients; the average patient age was 22.4 years (range 15–50 years). The most common presenting symptoms were productive cough in 197 (58.1 %) patients. There were 21 (6.2 %) asymptomatic patients. Two hundred and thirty of the 339 patients (67.8 %) had had previous medical therapy before admission to our department. The most common etiology of bronchiectasis was childhood infections in 101 (29.8 %) patients. In most patients, bronchiectasis was found on the left side (n = 225, 66.4 %). Thirty-five patients underwent a second operation for bilateral disease. There were two (0.6 %) early postoperative mortalities including one myocardial infarction and one respiratory insufficiency. Complications occurred in 43 patients (12.7 %). The median follow-up was 13.6 months. Symptoms disappeared in 201 patients (71 %), and 66 patients (23.3 %) experienced an improvement, while 16 patients (5.7 %) continued to be symptomatic. Conclusion: Although improvements in medical treatment have resulted in a significant decrease in the number of patients with bronchiectasis, surgical management is still very important in developing countries. Surgical resection can be performed with acceptable morbidity and mortality rates. The aim should be the resection of all involved bronchiectatic sites, even in patients with bilateral disease, if the pulmonary reserve is adequate.

thoracic surgery - bronchial disease (includes injury - stenosis - tumor - etc.) - infection - bronchiectasis

References

• 1 Deslauries J, Goulet S, Francois B. Surgical treatment of bronchiectasis and broncholithiasis.. In: Franco L F, Putnam J B, eds. Advanced Therapy in Thoracic Surgery.. Hamilton, ON: Decker; 1998: 300-309
• 2 Raffensperger J G. Bronchiectasis.. In: Raffensperger J G, ed. Swenson's Pediatric Surgery.. Norwalk, CT: Appleton & Lange; 1990: 908-909
• 3 Ashour M, Al-Kattan K, Rafay M A, Saja K F, Hajjar W, Al-Fraye A R. Current surgical therapy for bronchiectasis.  World J Surg. 1999;  23 (11) 1096-1104
• 4 Amnest L S, Kratz J M, Crawford Jr F A. Current results of treatment of bronchiectasis.  J Thorac Cardiovasc Surg. 1982;  83 546
• 5 George S A, Leonardi H K, Overholt R H. Bilateral pulmonary resection for bronchiectasis: a 40-year experience.  Ann Thorac Surg. 1979;  28 48-53
• 6 Kutlay H, Cangir A K, Enon S et al. Surgical treatment in bronchiectasis: analysis of 166 patients.  Eur J Cardiothorac Surg. 2002;  21 (4) 634-637
• 7 Agasthian T, Deschamps C, Trastek V F, Allen M S, Pairolero P C. Surgical management of bronchiectasis.  Ann Thorac Surg. 1996;  62 (4) 976-978
• 8 Yuncu G, Ceylan K C, Sevinc S et al. Functional results of surgical treatment of bronchiectasis in a developing country.  Arch Bronconeumol. 2006;  42 (4) 183-188
• 9 Dogan R, Alp M, Kaya S et al. Surgical treatment of bronchiectasis: a collective review of 487 cases.  Thorac Cardiovasc Surg. 1989;  37 (3) 183-186
• 10 Balkanlı K, Genc O, Dakak M et al. Surgical management of bronchiectasis: analysis and short-term results in 238 patients.  Eur J Cardiothorac Surg. 2003;  24 (5) 699-702
• 11 Mazieres J, Muris M, Didier A et al. Limited operation for severe multisegmental bilateral bronchiectasis.  Ann Thorac Surg. 2003;  75 (2) 382-387
• 12 Prieto D, Bernardo J, Matos J M, Eugenio L, Antunes L. Surgery for bronchiectasis.  Eur J Cardiothorac Surg. 2001;  20 19-24
• 13 Brooke Nicotra M, Rivera M, Dale A M, Shepherd R, Carter R. Clinical, pathophysiologic, and microbiologic characterization of bronchiectasis in an aging cohort.  Chest. 1995;  108 955-961
• 14 Fujimoto T, Hillejan L, Stamatis G. Current strategy for surgical management of bronchiectasis.  Ann Thorac Surg. 2001;  72 1711-1715
• 15 Sırmalı M, Karasu S, Turut H et al. Surgical management of bronchiectasis in childhood.  Eur J Cardiothorac Surg. 2007;  31 120-123
• 16 Cook J C, Currie D C, Morgan A D et al. Role of computed tomography in diagnosis of bronchiectasis.  Thorax. 1987;  42 272-277
• 17 Grenier P, Maurice F, Musset D, Menu Y, Nahum H. Bronchiectasis: assessment by thin-section CT.  Radiology. 1986;  161 95-99
• 18 Dogan R, Kara M, Gundogdu A G, Firat P. An underrated potential risk of bronchiectasis: lymph node metastasis of a pulmonary tumorlet.  Acta Chir Belg. 2009;  109 (1) 109-111