Surgery for lung abscess in immunocompetent and immunocompromised children.
OBJECTIVE
The aim of this study was to evaluate the surgical management results of lung abscess in immunocompetent and immunocompromised children.


METHODS
Surgery was performed on 30 children with lung abscess or necrotizing pneumonia refractory to medical treatment in a 12-year period. Of them, 23 were immunocompetent, and 7 were immunocompromised. Pulmonary resection was performed including unilateral lung in 28, bilateral in 2, and 2 lobes in 6. Concomitant decortication was performed in 18 (78.2%) immunocompetent patients.


RESULTS
Increased incidence of surgery for lung abscess was caused mainly by drug-resistant and fungal infection. Surgery was performed commonly for bacterial lung abscess on patients less than 5 years old and fungal lung abscess on adolescence. A multiple small abscess was the predominant type of abscess in immunocompetent patients, whereas 2-lobe involvement tended to occur in immunocompromised patients. Fungal lung abscess tended to occur on left lung and in female patients. Left lower lobe was involved most commonly in both groups of patients in which majority need lobectomy. Immunocompromised patients required a more extensive pulmonary resection. There were 3 postoperative complications (morbidity of 10.2%) with no postoperative mortality. Length of postoperative hospital stay ranged from 6 to 85 days with average of 18.4 days.


CONCLUSIONS
The incidence and pattern of lung abscess that required surgery between immunocompetent and immunocompromised children were different. A more aggressive, extensive surgical procedure is preferable for immunocompromised patients, and the surgical results were comparatively excellent to immunocompetent patients. However, the prognosis of immunocompromised children depends on their underlying disease process.
Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republiuc of China.
Y L
YL
Tseng
M H
MH
Wu
M Y
MY
Lin
W W
WW
Lai
C C
CC
Liu
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007121:Immunocompetence; D016867:Immunocompromised Host; D007223:Infant; D008169:Lung Abscess / Q000209:etiology / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D008297:Male; D011013:Pneumonectomy / Q000379:methods*; D011014:Pneumonia / Q000150:complications*; D011183:Postoperative Complications; D013624:Taiwan / Q000453:epidemiology