OBJECTIVES: Compared to the use of anti-TB drugs for the treatment of tuberculosis (TB), surgery is destructive and is associated with higher risk. Whether surgery is needed for the treatment of TB-destroyed lungs (for short: destroyed lungs) is still controversial and unresolved in the clinic. METHODS:Retrospective analysis of treatment efficacy was performed on 172 cases of destroyed lungs (176 surgeries) in the Thoracic Surgery Department of our hospital from April 1992 to June 2010. RESULTS:A total of 83 male and 89 female patients was analyzed. The youngest patient was 7 years old, and the oldest was 72 years old, with a mean age of 38.4 years. A total of 120 cases had a preoperative cough, 31 cases had fever, and 42 cases had hemoptysis. A total of 49 cases was positive for Mycobacterium tuberculosis by sputum test before surgery, yielding a positive TB rate of 28.5% (49/172). A total of 116 patients had a destroyed left lung and 56 cases had a destroyed right lung. In all, 110 cases underwent total pneumonectomy, 37 pleuropneumonectomy, one lobectomy, 10 residual lobectomy, two total pneumonectomy and tracheoplasty, 11 cases bronchopleural fistula (BPF) repair and other surgeries, and one case underwent thoracoplasty. A total of four patients underwent thoracoplasty 30 days after surgery due to a thoracic cavity infection or empyema. The overall perioperative mortality rate was 2.9% (5/172). The surgical complication rate was 18.6% (32/172). The sputum negative conversion rate was 87.8% (43/49), and the clinical cure rate was 91.9% (158/172). CONCLUSIONS:Our findings suggested that surgical treatment efficacy in destroyed lungs was satisfactory with strict surgical indications, standard preoperative anti-TB treatment, adequate preoperative preparation, and careful intraoperative operations.

Background To evaluate the efficacy and safety of surgical treatment of tuberculosis destroyed lung (TDL), and the influence of chronic pulmonary aspergillosis (CPA) on the outcomes of surgical treatment of TDL. Methods We performed a retrospective analysis of 113 patients with TDL who underwent surgical treatment from January 2005 to December 2019. Among them, 30 of these cases were complicated with CPA. The patients were divided into two groups: TDL group and TDL + CPA group. We analyzed the effectiveness and safety of surgical treatment of TDL, and further compared the effectiveness and safety of surgical treatment of TDL with or withoutthe presence of CPA. Results The TDL + CPA group had a significantly higher age (P=0.003), symptoms of hemoptysis (P=0.000), and a higher proportion of patients with preoperative serum albumin <30 g/L (P=0.014) as compared with TDL group. For all enrolled patients, the incidence of severe postoperative complications was 12.4% (14/113) and the postoperative mortality within 30 days after discharge was 4.4% (5/113). 86.7% (98/113) of the patients recovered and discharged, the incidence of severe postoperative complications in the TDA + CPA group was higher than that of TDL group (23.3% vs 8.4%, P = 0.034), although there was no difference in mortality between the two groups (P = 1.000). A binary logistic regression analysis showed that the independent risk factors for severe postoperative complications were male (OR 25.24, 95% CI 2.31–275.64; P = 0.008) and age ≥ 40 years (OR 10.34, 95% CI 1.56–68.65; P = 0.016). Conclusion Surgical treatment for patients with TDL is effective with an acceptable mortality rate whether or not the disease is complicated with CPA. The independent risk factors identified for severe postoperative complications in patients with TDL were male and ≥ 40 years old. It implies that when treating patients with TDA + CPA, particular attention should be paid to these patients who have these independent risk factors to avoid a poor outcome.

Background The purpose of this study was to determine risk factors of postoperative complications in tuberculosis-destroyed lung (TDL) patients. Methods We retrospectively analyzed the data from all consecutive TDL patients undergoing surgical treatment at the Beijing Chest Hospital from January 2001 to September 2019. Results Of 113 TDL cases experiencing surgery, 33 (29.2%) experienced postoperative complications. The patients with low BMI were more likely to have postoperative complications compared to those with normal BMI, whereas a significant lower rate of postoperative complications was noted in patients with BMI ≥ 25 kg/m2. In addition, significant increased risk was observed in patients with smoking history. We found that the patients with underlying infection, including aspergillus and nontuberculous mycobacteria (NTM), had significantly higher odds of having postoperative complications compared with those without underlying infection. The anaemia was another important independent factor associated with postoperative complication. Patients with blood transfusion above 1000 mL had a strongly increased frequency of postoperative complications than patients with blood transfusion below 1000 mL. Conclusion In conclusion, our data demonstrate that approximate one third of TDL patients experience postoperative complications in our cohort. Patients with low BMI, anaemia, tobacco smoking, and coinfected aspergillus or NTM are at markedly higher risk to experience postoperative complications after pneumonectomy.