Computed tomographic assessment of the surgical risks associated with fibrocavernous pulmonary tuberculosis.
OBJECTIVE
We evaluated the surgical risks associated with fibrocavernous pulmonary tuberculosis by retrospectively examining chest computed tomography (CT) scans.


METHODS
We reviewed the records of 40 patients who underwent pulmonary resection for fibrocavernous pulmonary tuberculosis, for whom preoperative CT scans were available. The disease was categorized as class I, defined as a cavity within one lobe without remarkable pleural thickness, in 21 patients; class II, defined as a cavity extending beyond one lobe or within one lobe with remarkable pleural thickness, in 10 patients; and class III, defined as bilateral cavities, in 9 patients. Four of the nine patients with bilateral cavities underwent bilateral pulmonary resection and five underwent unilateral pulmonary resection. The study parameters were intraoperative blood loss, operative time, hospital stay, major operative morbidity, and hospital death.


RESULTS
Intraoperative blood loss and operative time were significantly greater and hospital stay was significantly longer in patients with advanced disease (P = 0.046, P = 0.000, and P = 0.143, respectively). Major surgical morbidity mainly occurred in association with advanced disease (P = 0.028) at the following incidences: class I, 5%; class II, 30%; class III, 44.4%. Two hospital deaths occurred, both following bilateral pulmonary resection for class III disease, accounting for an overall 5% mortality rate.


CONCLUSIONS
The surgical risks associated with fibrocavernous pulmonary tuberculosis were well correlated with anatomic involvement, according to the extent of cavitation and the severity of pleural thickness, as depicted by CT. Staged pulmonary resection or the combination of one-sided resection with other modalities is recommended for the treatment of bilateral cavities.
Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-li Road, Tainan, Taiwan.
Ming-Ho
MH
Wu
Jia-Ming
JM
Chang
Tsung-Mao
TM
Haung
Li-Li
LL
Cheng
Yau-Lin
YL
Tseng
Mu-Yen
MY
Lin
Wu-Wei
WW
Lai
D016063:Blood Loss, Surgical; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*