Clinical analysis of pneumonectomy for destroyed lung: a retrospective study of 32 patients

Left Versus Right Destroyed Lung Pneumonectomy: Long Term Prognosis and Key Factors Associated With Poor Treatment Outcomes

INTRODUCTION

To compare and analyze postoperative short-term and long-term prognosis of destroyed lung (DL) disease patients undergoing left versus right pneumonectomy and to identify potential key factors associated with poor treatment outcomes.

METHODS

Retrospective analysis was conducted on clinical data of 128 DL patients who underwent pneumonectomy in the thoracic surgery department of the Beijing Chest Hospital from November 2001 to May 2022. Cases were assigned to two groups according to lesion site: a left pneumonectomy group (104 cases) and right pneumonectomy group (24 cases). Postoperative short-term and long-term DL disease clinical features and prognostic factors were analyzed and compared between groups.

RESULTS

As compared with the left pneumonectomy group, the right pneumonectomy group experienced greater rates of preoperative diabetes, chronic pulmonary aspergillosis, intraoperative blood loss, postoperative respiratory failure, rehospitalization, tuberculosis (TB) recurrence, bronchopleural fistula (BPF) and empyema. Binary logistic regression analysis revealed a potential correlation between chronic pulmonary aspergillosis and increased odds of developing secondary respiratory failure (adjusted odds ratio: 5.234, 95% confidence interval [CI]: 1.768-15.498). Results of Cox Proportional Hazards Model regression analysis suggested that right pneumonectomy was correlated with increased odds of TB recurrence (adjusted hazard ratio: 4.017, 95% CI: 1.282-12.933) and BPF/empyema (adjusted hazard ratio: 5.655, 95% CI: 1.254-25.505).

CONCLUSIONS

Compared to the group undergoing left pneumonectomy, patients with DL who undergo right-sided pneumonectomy may be at a heightened risk of experiencing secondary postoperative TB recurrence and BPF or edema. It is advised to exercise utmost caution and deliberate consideration of these potential risks when contemplating pneumonectomy, with the intention of proactively preventing adverse events.

A left-sided destroyed lung in a 11-year-old girl: A rare sequela after Mycoplasma pneumoniae infection

Mycoplasma pneumoniae infection is one of the most common causes of community-acquired pneumonia in children, usually experiencing a favorable prognosis.Cases of M. pneumoniae infection resulting in respiratory failure, severe pulmonary or extrapulmonary sequelae, and death are relatively rare.Currently, no cases related to a destroyed lung with Mycoplasma-associated infection have been reported.Therefore, we report a case of a destroyed lung in an 11-year-old girl with Mycoplasma-associated infection.

Does the presence of systemic artery-pulmonary circulation shunt during bronchial arterial embolization increase the recurrence of noncancer-related hemoptysis? A retrospective cohort study

BACKGROUND

The presence of systemic artery-pulmonary circulation shunt (SPS) during the bronchial arterial embolization (BAE) procedure, has been inferred to be a potential risk factor for recurrence. The aim of this study is to reveal the impact of SPS on the recurrence of noncancer-related hemoptysis after BAE.

METHODS

In this study, 134 patients with SPS (SPS-present group) and 192 patients without SPS (SPS-absent group) who underwent BAE for noncancer-related hemoptysis from January 2015 to December 2020 were compared. Four different Cox proportional hazards regression models were used to clarify the impact of SPSs on hemoptysis recurrence after BAE.

RESULTS

During the median follow-up time of 39.8 months, recurrence occurred in 75 (23.0%) patients, including 51 (38.1%) in the SPS-present group and 24 (12.5%) in the SPS-absent group. The 1-month, 1-year, 2-year, 3-year and 5-year hemoptysis-free survival rates in the SPS-present and SPS-absent groups were 91.8%, 79.7%, 70.6%, 62.3%, and 52.6% and 97.9%, 94.7%, 89.0%, 87.1%, and 82.3%, respectively (P < 0.001). The adjusted hazard ratios of SPSs in the four models were 3.37 [95% confidence intervals (CI), 2.07-5.47, P < 0.001 in model 1], 1.96 (95% CI, 1.11-3.49, P = 0.021 in model 2), 2.29 (95% CI, 1.34-3.92, P = 0.002 in model 3), and 2.39 (95% CI, 1.44-3.97, P = 0.001 in model 4).

CONCLUSIONS

The presence of SPS during BAE increases the recurrence probability of noncancer-related hemoptysis after BAE.

Comparison of Bronchial Artery Embolisation Versus Conservative Treatment for Bronchiectasis-Related Nonmassive Haemoptysis: A Single-Centre Retrospective Study

OBJECTIVE

To compare the safety and effectiveness between bronchial artery embolisation (BAE) and conservative treatment for bronchiectasis-related nonmassive haemoptysis patients.

MATERIALS AND METHODS

From January 2015 to December 2020, consecutive bronchiectasis-related nonmassive haemoptysis patients who underwent either BAE (n = 98) or conservative treatment (n = 118) were included. Treatment-related complications, length of hospital stays, clinical success rate, patient satisfaction, and recurrence-free survival rates were compared between groups. Prognostic factors related to recurrence were also analysed.

RESULTS

During a median follow-up time of 44.8 months (range, 2.4-83.6 months), 34 and 66 patients in the BAE and conservative treatment groups suffered relapse. The 1-year, 2-year, 3-year and 5-year haemoptysis-free survival rates in the BAE and conservative treatment groups were 79.2%, 68.1%, 62.8%, and 57.6% and 64.0%, 52.8%, 44.1%, and 37.0%, respectively (P = 0.007). The minor complication rate after BAE was higher than that after conservative treatment (23/98 vs. 12/118, P = 0.008). BAE was associated with shorter hospital stays (5.0 vs. 7.0 days, P = 0.042) and higher patient satisfaction (88.8% vs. 74.6%, P = 0.008) than those for conservative treatment and with comparable clinical success rates (95.9% vs. 91.5%, P = 0.192). Treatment type, haemoptysis duration, and bronchiectasis severity were independently significant predictors of recurrence for these patients.

CONCLUSIONS

BAE could be another option for bronchiectasis-related nonmassive haemoptysis patients. In the patients with longer duration and more severe bronchiectasis, BAE still appeared to have better long-term haemoptysis control than conservative therapy.

Long-term follow-up of tuberculosis-destroyed lung patients after surgical treatment

Background

To monitor dypsnea and mortality at 5 and 10 years, respectively, after surgical treatment of tuberculosis-destroyed lung (TDL) patients.

Methods

TDL patients treated surgically at Beijing Chest Hospital from November 2007 to June 2019 were monitored in this observational study. Follow-up assessments of respiratory function indicators and survival conducted 5 and 10 years post-surgery led to patient grouping based on mMRC score into a dyspnea group (mMRC ≥ 1) and a non-dyspnea group (mMRC = 0). Cox regression analysis detected effects of patient demographics, clinical characteristics, surgical factors and respiratory function on 5 year post-surgical survival.

Results

By study completion (June 30, 2020), 32 of 104 patients were lost and 72 completed follow-up for a study total of 258.9 person-years. 45 patients (62.5%, 45/72) had mMRC scores of 0, while 12 (16.7%, 12/72), 21 (36.2%, 21/58) and 27 (60.0%, 27/45) patients exhibited dyspnea by 1, 3 and 5 years post-surgery, respectively. Low lung carbon monoxide diffusion score (DLCO% pred) and scoliosis contributed to dyspnea occurrence.

Conclusions

Most TDL patients lacked subjective dyspnea signs post-surgery, while dyspnea rates increased with time. Preoperative low lung diffusion function and Scoliosis were associated with factors for postoperative dyspnea. Surgical treatment increased TDL patient survival overall.

Pneumonectomy in a child due to belated diagnosis of foreign body aspiration: a case report

Introduction

With early diagnosis, fiberoptic or rigid bronchoscopy methods are the gold standard in the management of tracheobronchial foreign body. Otherwise, nonrecognized bronchial foreign bodies cause irreversible damage to the airways and lungs. The deficiency of the health system noted in many developing countries such as Madagascar, combined with the fundamental problem relating to children’s conditions, which are determined by social and educational factors, makes it almost impossible to provide early and appropriate management of the penetration syndrome.

Case presentation

An 11-year-old Malagasy female patient was referred to our hospital for an investigation of the etiology of the patient’s hemoptysis. The investigations revealed a localized bronchiectasis and atelectasis due to a foreign body obstructing the left main bronchus. Based on the hemoptysis and left lung almost destroyed by an occlusive lesion within, we decided to proceed with left pneumonectomy. A retrospective interrogation revealed a choking episode 4 years prior in elementary school after the child sucked on a pen cap and involuntarily aspirated it. Two years after the pneumonectomy, our patient was doing well and was asymptomatic.

Conclusion

In this case report, we describe a rare case of a late presentation of foreign body aspiration that resulted in a left pneumonectomy in a child. Despite our favorable results, pneumonectomy must be the preferred last option. Preventive actions remain the optimal approach.

Bilateral Lung Transplantation for Patients With Destroyed Lung and Asymmetric Chest Deformity

Background: Destroyed lung can cause mediastinal displacement and asymmetric chest deformity. Reports on bilateral lung transplantation (LT) to treat destroyed lung and asymmetric chest deformity are rare. This study presents our surgical experience of bilateral LT among patients with destroyed lung and asymmetric chest deformity.

Methods: Six patients with destroyed lung and asymmetric chest deformity who underwent bilateral LT at our center from 2005 to 2020 were included in the study. Demographic data, technical data, perioperative details, and short-term follow-up data were reviewed.

Results: Three patients underwent bilateral LT via anterolateral incisions in the lateral position without sternal transection, while three patients underwent bilateral LT via clam-shell incisions in the supine position with sternal transection. Only one patient required intraoperative extracorporeal membrane oxygenation. Four patients underwent size-reduced LT. In the other two patients, we restored the mediastinum by releasing mediastinal adhesions to ensure maximal preservation of the donor lung function. Patients in the lateral position group had a higher volume of blood loss, longer operation time, and longer postoperative in-hospital stay than those in the supine position group. However, these differences were not statistically significant. Postoperative computed tomography in the supine position group revealed that the donor lungs were well expanded and the mediastina were in their original positions.

Conclusions: Although bilateral LT in patients with destroyed lung and asymmetric chest deformity is high risk, with sufficient preoperative preparation and evaluation, it is safe and feasible to perform bilateral LT for selected patients. For patients without severe chest adhesions, releasing the mediastinal adhesions and restoring the mediastinum through a clam-shell incision in the supine position is a simple and effective method to maximally preserve the donor lung function without pneumonectomy or lobectomy.

A Nomogram to Predict Recurrence After Bronchial Artery Embolization for Hemoptysis Due to Bronchiectasis

OBJECTIVE

To develop and validate a nomogram for predicting recurrent hemoptysis after successful bronchial arterial embolization (BAE) in patients with bronchiectasis.

MATERIALS AND METHODS

From January 2015 to December 2019, a total of 251 patients were enrolled in this study. A nomogram was developed with the predictors of recurrent events, which were identified by univariate and multivariate Cox regression analyses. We evaluated nomogram discrimination by area under the receiver operating characteristic curve, calibration by the calibration curve, and clinical usefulness potential by decision curve analysis.

RESULTS

The one-month, 1-year, 2-year, 3-year, and 5-year cumulative recurrence-free rates of patients were 98.4%, 90.5%, 82.8%, 77.7%, and 74.4%, respectively. Three predictive factors, namely sex, lung destruction, and systemic arterial-pulmonary circulation shunts, were applied to develop the nomogram. The model maintained good discrimination (area under the curve, 0.72; 95% confidence interval, 0.62-0.81), low prediction error (integrated Brier score, 0.129), and certain net benefits in terms of clinical usefulness.

CONCLUSIONS

The proposed nomogram showed favorable predictive efficacy for hemoptysis recurrence after BAE in patients with bronchiectasis. Improved long-term outcomes are expected with close follow-up, a healthy lifestyle, and pulmonary rehabilitation for patients at risk of recurrence according to the model.

Clinical and surgical analysis of lobectomy for destroyed lobe of the lung: A series of 47 patients

OBJECTIVE

Destroyed lobe of the lung is always secondary to chronic or recurrent lung infections with irreversible damage of pulmonary parenchyma. In this study, we analyzed surgical technique, post-operative complications, mortality, and long-term outcomes of patients undergoing lobectomy of pulmonary lobe destruction.

MATERIALS AND METHODS

A retrospective study of 47 patients that underwent lobectomy due to a destroyed lung parenchyma between January 2010 and December 2019 were reviewed with an average follow-up period of 39 months.

RESULTS

The study included 47 patients with a mean age of 39.4 years. The etiology of lobe destroyed was tuberculosis in 15 (31.9%), non-tuberculosis bronchiectasis in 20 (42.5%), aspergilloma in 09 (19.1%), hydatid cyst in 2 (4.3%), and a mis-diagnosed intrabronchic foreign body in 1 (2.1%). Surgical approach was through posterolateral thoracotomy in 44 (93.6%) patients and video-assisted thoracoscopic surgery in only 3 patients. Mean operative time was 153 min and mean post-operative hospital stay was 7.9 days. The post-operative complications occurred in five (10.6%): atelectasis (n  =  2), wound site infection (n = 1), prolonged air leak (n = 1), and hemothorax in one case. No post-operative mortality was noted. A good clinical result was observed in 87.2% of cases.

CONCLUSION

Surgical treatment of destroyed lobe is a high risk associated surgery. Tuberculosis and aspergilloma are the most common etiologies. Favorable result was obtained in selected patient with an excellent perioperative care.

Video-assisted thoracoscopic pneumonectomy for destroyed lung

AIM

Destroyed lung refers to destruction of a large portion of a lung induced by chronic or recurrent lung infections. The aim of this single-center retrospective review was to evaluate patients with a diagnosis of destroyed lung undergoing pneumonectomy via video-assisted thoracoscopic surgery, in terms of surgical technique, postoperative morbidity and mortality, and long-term outcomes.

METHODS

Data of 15 patients who underwent video-assisted thoracoscopic pneumonectomy for destroyed lung during a 4-year period were analyzed retrospectively. There were 9 (60%) males and 6 (40%) females with a median age of 33.87 years (range 8-52 years). Bronchiectasis (n = 7), tuberculosis (n = 5), and fungal infection (n = 3) were the main etiologies. Hemoptysis was the most common presenting symptom (n = 8, 53.3%). Destroyed lung was detected on the left side in 13 (86.7%) patients and on the right side in 2 (13.3%). Seven patients showed narrowing or thickening of the main bronchus.

RESULTS

Video-assisted thoracoscopic pneumonectomy was attempted in all patients but 5 (33.3%) were converted to a thoracotomy. The mean operative time was 273.8 min. The postoperative morbidity rate was 13.3%. The mortality rate was 6.67%. The median length of hospital stay was 3.5 days. The mean follow-up period was 23.7 months. Significant improvement was observed in inflammatory symptoms and quality of life in all patients. The overall 1-year survival was 93.3%.

CONCLUSION

Video-assisted thoracoscopic pneumonectomy for destroyed lung is a safe and feasible option in selected patients, which can be used as an alternative to thoracotomy.

Post-Tuberculosis (TB) Treatment: The Role of Surgery and Rehabilitation

Even though the majority of tuberculosis (TB) programmes consider their work completed when a patient is ‘successfully’ cured, patients often continue to suffer with post-treatment or surgical sequelae. This review focuses on describing the available evidence with regard to the diagnosis and management of post-treatment and surgical sequelae (pulmonary rehabilitation). We carried out a non-systematic literature review based on a PubMed search using specific key-words, including various combinations of ‘TB’, ‘MDR-TB’, ‘XDR-TB’, ‘surgery’, ‘functional evaluation’, ‘sequelae’ and ‘pulmonary rehabilitation’. References of the most important papers were retrieved to improve the search accuracy. We identified the main areas of interest to describe the topic as follows: 1) ‘Surgery’, described through observational studies and reviews, systematic reviews and meta-analyses, IPD (individual data meta-analyses), and official guidelines (GRADE (Grading of Recommendations Assessment, Development and Evaluation) or not GRADE-based); 2) Post-TB treatment functional evaluation; and 3) Pulmonary rehabilitation interventions. We also highlighted the priority areas for research for the three main areas of interest. The collection of high-quality standardized variables would allow advances in the understanding of the need for, and effectiveness of, pulmonary rehabilitation at both the individual and the programmatic level. The initial evidence supports the importance of the adequate functional evaluation of these patients, which is necessary to identify those who will benefit from pulmonary rehabilitation.

Right thoracotomy approach for treatment of left bronchopleural fistula after pneumonectomy for tubercolosis

Pneumonectomy for pulmonary tuberculosis is a rare option but can sometimes be necessary in cases of destroyed lung, resulting from a previous or persistent chronic infection. Bronchopleural fistula on the bronchial stump may develop as a postoperative complication, favoured by the long-lasting infectious disease and the poor nutritional status. Right-sided approach can be used for treatment of left bronchopleural fistula after pneumonectomy. We report a rare case of left bronchopleural fistula after pneumonectomy for pulmonary tuberculosis in a 38-year-old woman, treated by re-closure and re-stapling of the left main bronchial stump through a right thoracotomy approach. The patient is in excellent general condition and without evidence of bronchopleural fistula and tuberculosis at 3 years from re-closure of the left bronchial stump through right thoracotomy. This approach allowed a successful and safe management of our case of left bronchopleural fistula after pneumonectomy for tuberculosis, without short and long-term complications.