Surgical results for bronchiectasis based on hemodynamic (functional and morphologic) classification

Task Force report: European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis

There is increasing awareness of bronchiectasis in children and adolescents, a chronic pulmonary disorder associated with poor quality-of-life for the child/adolescent and their parents, recurrent exacerbations and costs to the family and health systems. Optimal treatment improves clinical outcomes. Several national guidelines exist, but there are no international guidelines.The European Respiratory Society (ERS) Task Force for the management of paediatric bronchiectasis sought to identify evidence-based management (investigation and treatment) strategies. It used the ERS standardised process that included a systematic review of the literature and application of the GRADE approach to define the quality of the evidence and level of recommendations.A multidisciplinary team of specialists in paediatric and adult respiratory medicine, infectious disease, physiotherapy, primary care, nursing, radiology, immunology, methodology, patient advocacy and parents of children/adolescents with bronchiectasis considered the most relevant clinical questions (for both clinicians and patients) related to managing paediatric bronchiectasis. Fourteen key clinical questions (7 "Patient, Intervention, Comparison, Outcome" [PICO] and 7 narrative) were generated. The outcomes for each PICO were decided by voting by the panel and parent advisory group.This guideline addresses the definition, diagnostic approach and antibiotic treatment of exacerbations, pathogen eradication, long-term antibiotic therapy, asthma-type therapies (inhaled corticosteroids, bronchodilators), mucoactive drugs, airway clearance, investigation of underlying causes of bronchiectasis, disease monitoring, factors to consider before surgical treatment and the reversibility and prevention of bronchiectasis in children/adolescents. Benchmarking quality of care for children/adolescents with bronchiectasis to improve clinical outcomes and evidence gaps for future research could be based on these recommendations.

Bronchiectasis: Experience of Surgical Management at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Background

Bronchiectasis is one of the major health problems in Ethiopia. We analyzed the outcome of surgery done for bronchiectasis in a resource-limited setup.

Methods

A retrospective cross-sectional analysis of 22 patients who underwent surgery for bronchiectasis in Tikur Anbessa specialized hospital (TASH) during the period 2012 – 2017 were done.

Results

There were 13(59%) female and 9(41%) male patients with a mean age of 34.1 +/−16.9 years. The mean duration of symptoms was 2.2 years. Blood streak sputum, 13(59%), dyspnea, 9(49.9%), fetid sputum, 8(36.4%), dry cough, 6(27.3%), chest pain, 6(27.3%) and massive hemoptysis 3(13.6%) were the main presenting symptoms. In 20(91%) of the patients, previous history of TB treatment was identified. Recurrent childhood infection, 1(4.5%), and tumor obstruction, 1(4.5%), were also seen. Bronchiectasis was left sided in 12(54.5%), right-sided in 7(31.8%) and bilateral in 3(13.6%) patients. The disease affected multiple lung lobes in 9(40.9%), left lower lobe in 6(27.3%) and left upper lobe in 3(13.6%) cases. Indications for surgery were the failure of medical management in 10(45.5%), destroyed lung in 9(40.9%), and massive hemoptysis in 3(13.6%) cases. The procedures performed were lobectomy in 14(63.6%) and pneumonectomy in 8(36.4%) cases. Postoperative complications occurred in 5(22.7%) patients with one (4.5%) death. On the other hand, 77.3% of operated patients had significant improvement compared to their preoperative symptoms.

Conclusions

In a resource-limited setup like TASH, localized bronchiectasis can be treated surgically with an acceptable result. Proper selection and preparation with complete resection of the involved segments are needed for maximum control of symptoms and better outcomes.

Surgical Treatment of Bronchiectasis: 5 Years of Experience at a Single Institution

Objective: The aim of this retrospective study was to present our surgical experience in patients with bronchiectasis who underwent thoracoscopy and to compare the results with those of patients who underwent thoracotomy. Methods: We analyzed the medical records of patients who underwent lung resection to treat bronchiectasis through video-assisted thoracoscopic surgery (VATS) or open lung resection between November 2012 and November 2017. Results: In total, 99 patients were enrolled. Forty-nine patients with bronchiectasis underwent VATS lung resection and 50 patients underwent thoracotomy. The patients in the VATS group were older (P = .025), but no difference was observed in blood loss (P = .62) or morbidity (P = .67) between the two groups. The patients in the VATS group had a shorter duration of chest tube placement (P = .01) and length of hospital stay (P = .04) but a longer operative time (P = .01). No significant difference was found in symptom improvement between the two groups (P = .694). Conclusions: Surgical resection for bronchiectasis can be performed with acceptable morbidity and can lead to significant relief of symptoms. Video-assisted thoracoscopic lung resection for localized bronchiectasis is a safe and efficient procedure that results in good recovery.

[Results of bronchiectasis surgery: About 64 cases]

INTRODUCTION

Bronchiectasis is a serious and disabling disease. Surgical treatment is an interesting alternative to be proposed early to patients in case of complications or deterioration of quality of life, despite an optimal medical treatment. Through this retrospective study and literature review, we analyze surgical results for bronchiectasis.

PATIENTS AND METHOD

We conducted a monocentric, retrospective, descriptive and analytical study in the Department of thoracic surgery of CHU Hassan II Fès, about 64 patients operated for bronchiectasis during the period from January 2009 to December 2016.

RESULTS

There were 30 men and 34 women with an average age of 32years. Twenty six percent (26 %) had a history of recurrent lung infection, and 17.18 % would have been treated for pulmonary tuberculosis and declared cured. Productive cough (93 %), morning chronic bronchorrhea (92 %) and repeatedly hemoptysis (62.5 %) were the main symptoms. On CT scanning, the bronchiectasis was unilateral and localized in 49 cases. The right lung was involved in 27 cases and the location was bilateral in 15 cases. It was 38 cystic bronchiectasis, 16 cylindrical bronchiectasis, and 10 mixed lesions predominantly cylindrical. The flexible bronchoscopy carried out in 34 cases, had shown a carcinoid tumor in 1 case, a bronchiolithiasis in 1 case and a intrabronchial foreign body in 1 case. The incision was a conservative posterolateral thoracotomy in all cases. The performed surgical procedure was lobectomy in 53 % of patients. The morbidity rate was 32.80 % and dominated by septic complications. After a mean follow-up of 20.52months, 2 cases of recurrence minimal hemoptysis and 1 case of renewed bronchorrhea are noted. For all other patients the outcome was favorable and no deaths have been noted to date.

CONCLUSION

The surgery of bronchiectasis requires a perfect collaboration between the pulmonologist, the thoracic surgeon, the anesthesiologist, the biologist and particularly the physiotherapist for an optimal care of patients.

The Saudi Thoracic Society guidelines for diagnosis and management of noncystic fibrosis bronchiectasis

This is the first guideline developed by the Saudi Thoracic Society for the diagnosis and management of noncystic fibrosis bronchiectasis. Local experts including pulmonologists, infectious disease specialists, thoracic surgeons, respiratory therapists, and others from adult and pediatric departments provided the best practice evidence recommendations based on the available international and local literature. The main objective of this guideline is to utilize the current published evidence to develop recommendations about management of bronchiectasis suitable to our local health-care system and available resources. We aim to provide clinicians with tools to standardize the diagnosis and management of bronchiectasis. This guideline targets primary care physicians, family medicine practitioners, practicing internists and respiratory physicians, and all other health-care providers involved in the care of the patients with bronchiectasis.

[The place of surgery in bilateral sequelae bronchiectasis]

INTRODUCTION

The aim of our study is to report our surgery results in bilateral sequelae bronchiectasis and to assess its impact on the life quality of our patients.

METHOD

This is a retrospective descriptive study in thoracic surgery department of Teaching Hospital Hassan II of Fez in Morocco. It involved all patients with bilateral bronchiectasis which is predominant on a few lobes or segments (localized) and who underwent surgery during the period 2010-2015. The epidemiological, clinical and paraclinical data, the surgery results, the evolution and the impact on life quality were assessed.

RESULTS

From a total of 47 patients with bilateral bronchiectasis, 13 were operated, thus a frequency of 27.6%. The average age was 32years, ranging from 15 to 54years. Women were in majority (61.5%) representing a sex ratio of 1.6. The association of chronic bronchorrhea and hemoptysis was the main reason of medical consultation in 46.16%, followed by isolated chronic bronchorrhea in 38.46%. Surgical resection involved the left side in 61.5% of cases. The left lower lobectomy was the most accomplished gesture. An improvement in symptoms was found in 11 patients (84.6%) as a decrease in bronchorrhea, hemoptysis episodes and decreasing use of antibiotics.

CONCLUSION

Bilateral bronchiectasis surgery can be performed with acceptable morbidity and mortality in well-selected patients with an improvement in symptoms.

Surgery for predominant lesion in nonlocalized bronchiectasis

OBJECTIVE

Patients with nonlocalized bronchiectasis are encountered commonly; however, there is little information regarding surgical intervention in this patient population. The aim of this study was to evaluate symptomatic response and safety of anatomic resection of the predominant lesion via the use of lobectomy for the management of nonlocalized bronchiectasis.

METHODS

We reviewed the medical records of 37 consecutive patients who underwent lobectomy via thoracotomy for nonlocalized bronchiectasis between 2010 and 2013. The main surgical indications were nonlocalized bronchiectasis with one predominant lesion, failure of medical treatment, and adequate cardiopulmonary reserve. The predominant lesion was determined by preoperative computed tomography and/or bronchoscopy. Preoperative symptoms were compared with postoperative symptoms and analyzed by the use of paired techniques.

RESULTS

The mean patient age was 54.5 ± 6.4 years. There was no operative mortality. Postoperative complications occurred in 8 (21.6%) patients, including 1 with empyema, 1 with persistent air leak, and 6 with minor transient complications, all of which were manageable without any reoperation. After lobectomy, the median extent of residual bronchiectatic areas in the remaining lungs was 25% (range, 12.5%-42.9%). The frequency of acute infection (5.3 ± 2.1/year vs 1.8 ± 2.3/year) and hemoptysis (4.9 ± 2.8/year vs 1.1 ± 0.7/year) decreased significantly and the amount of sputum also decreased (37.1 ± 3.4 mL/day vs 10.7 ± 4.6 mL/day). Twenty-three (62.2%) patients were asymptomatic after surgery, 10 (27.0%) were symptomatic with clinical improvement, and 4 (10.8%) had no change or worsened.

CONCLUSIONS

Lobectomy for the predominant lesion is a safe procedure in the surgical treatment of nonlocalized bronchiectasis and leads to significant relief of symptoms with good rates of satisfaction.

Efficiency and safety of surgical intervention to patients with Non-Cystic Fibrosis bronchiectasis: a meta-analysis

No quantitative systematic review was found to report the efficiency and safety of surgical resection in the management of non-cystic fibrosis (non-CF) bronchiectasis. We therefore conducted a meta-analysis to assess the effects of operative intervention to patients with non-CF bronchiectasis. PubMed, the Cochrane library and Web of Science databases were searched up to July 8th, 2015. The pooled mortality from 34 studies recruiting 4788 patients was 1.5% (95% CI, 0.9–2.5%). The pooled morbidity from 33 studies consisting of 4583 patients was 16.7% (95% CI, 14.8–18.6%). The pooled proportion of patients from 35 studies, consisting of 4614 patients who were free of symptoms was 66.5% (95% CI, 61.3–71.7%) after surgery. The summary proportion of patients from 35 articles including 4279 participants who were improved was 27.5% (95% CI, 22.5–32.5%), and 9.1% (95% CI, 7.3–11.5%) showed no clinical improvement. In conclusion, our analysis indicated that lung resection in the management of non-CF bronchiectasis is associated with significant improvements in symptoms, low risk of mortality and acceptable morbidity.

Rare presentation of bronchiectasis with multiple bronchial stones

The incidence of bronchiectasis has declined markedly in developed countries with improvement in health care, antibiotics, vaccines and control of tuberculosis (<0.6/1000 persons), but is still high in developing countries. Early complete resection of affected lung segment remains the mainstay of treatment as it causes maximum improvement in symptoms, minimum deterioration of lung function and prevents disease progression. Surgery is indicated in unsuccessful medical treatment and complications of bronchiectasis e.g. haemoptysis, lung abscess, lung masses and pneumothorax. Bronchiectasis with multiple broncholithiasis is a very rare presentation and very few cases have been reported in literature so far. This article presents here, the symptoms and signs, operative and perioperative management and literature review of a case of bronchiectasis with multiple bronchial stones.

Postsplenectomy left lower lobe bronchiectasis

BACKGROUND

Bronchiectasis has decreased significantly. I describe a new underestimated clinicopathological entity of postsplenectomy left lower lobe bronchiectasis.

METHODS

This is a retrospective study on 24 patients who had a left lower lobectomy for left lower lobe bronchiectasis after splenectomy. The mean age was 34.6 years (range 18 to 63 years); there were 19 men and 5 women. The available data included history, radiological investigations (ultrasonography and computed tomography of the chest and abdomen), operative data, postoperative complications, and follow-up data.

RESULTS

All patients had a history of splenectomy and 10 had undergone subphrenic collection drainage either percutaneously or through open drainage a few years prior to the left lower lobectomy. Fourteen patients were lost to follow-up. The mean follow-up in 10 patients was 5.8 years (range 2 to 13 years).

CONCLUSIONS

Postsplenectomy left lower lobe bronchiectasis is an underestimated clinicopathological entity of bronchiectasis. It can be managed by a left lower lobectomy, with acceptable results.

Surgical treatment of bronchiectasis: a retrospective observational study of 138 patients

BACKGROUND

We analyzed cases of bronchiectasis; its presentation, etiology, diagnosis, indications for surgery, surgical approach, and the outcome.

METHODS

A retrospective analysis of 138 patients who underwent surgery for bronchiectasis.

RESULTS

The mean age was 30.2±15.7 years. 55.8% patients were males. Symptoms were recurrent infection with cough in all patients, fetid sputum (79.7%), and hemoptysis (22.5%). The etiology was recurrent childhood infection (38.4%), pneumonia (29%), TB (9.4%), sequestration (4.3%), foreign body obstruction (4.3%), and unknown etiology (14.5%). CXR, CT scan, and bronchoscope were done for all patients. Bronchiectasis was left-sided in (55.1%) of patients. It was mainly confined to the lower lobes either alone (50.7%) or in conjunction with middle lobe or lingual (7.2%). Indications for resection were failure of conservative therapy (71.7%), hemoptysis (15.9%), destroyed lung (8%), and sequestration (4.3%). Surgery was lobectomy (81.2%), bilobectomy (8.7%), and pneumonectomy (8%). Complications occurred in 13% with no operative mortality. 84% of patients had relief of their preoperative symptoms.

CONCLUSIONS

Surgery for bronchiectasis can be performed with acceptable morbidity and mortality at any age for localized disease. Proper selection and preparation of the patients and complete resection of the involved sites are required for the optimum control of symptoms and better outcomes.

[Surgery for bronchiectasis]

The incidence of bronchiectasis has declined significantly in industrialized countries and its management has also changed because of the progress of antibiotic therapy. However, for some patients, medical treatment is not sufficient to control the disease and the quality of life is affected. Surgical treatment is then a very good alternative, when a gesture of complete resection of the affected areas is feasible in terms of lung function and it allows, with a low morbidity and mortality, for very satisfactory long-term results and slows down the progression of the disease. In cases of diffuse and inhomogeneous bronchiectasis, a gesture of incomplete resection of cystic, non-perfused and suppurative areas improves symptoms and reduces recurrent infections. When the bronchiectasis is diffuse, but homogeneous, associated with severe respiratory failure, lung transplantation should be considered. Therefore, surgery remains important in the management of bronchiectasis. Its indications and the lung resection gesture to achieve should be discussed based on the symptoms, imaging examinations and the lung function of the patient.