title: Surgery for predominant lesion in nonlocalized bronchiectasis.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China.
authors.forename: Jie
authors.initials: J
authors.lastname: Dai
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China.
authors.forename: Xinsheng
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China.
authors.forename: Dongliang
authors.initials: D
authors.lastname: Bian
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China.
authors.forename: Ke
authors.initials: K
authors.lastname: Fei
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China.
authors.forename: Gening
authors.initials: G
authors.lastname: Jiang
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China. Electronic address: zhangpeng1121@aliyun.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
mesh_terms: D001987:Bronchiectasis / Q000000981:diagnostic imaging / Q000601:surgery*; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D013908:Thoracotomy / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: bronchiectasis; nonlocalized; surgery