Thoracic Surgery an Alternative Safe Therapy for Non-CF Bronchiectasis Patients

Thoracic Surgery an Alternative Safe Therapy for Non-CF Bronchiectasis Patients

A team of researchers recently suggested that lung resection surgery is a safe and efficacious therapeutic for patients with non-cystic fibrosis (non-CF) bronchiectasis who fail to respond to conservative treatment. The study entitled “Efficiency and safety of surgical intervention to patients with Non-Cystic Fibrosis bronchiectasis: a meta-analysis” was published in the journal Scientific Reports.

Non-CF bronchiectasis is a disease of the respiratory tract characterized by irreversible bronchi dilation and persistent airway inflammation, as a result of successive bacteria infections and mucus production. Patients with non-CF bronchiectasis can experience chronic cough, sputum-pus secretion, and recurrent exacerbations culminating in a progressive destruction of the airways.

Therapeutics for non-CF bronchiectasis decrease patients’ symptoms, including decreasing cough and enhancing mucous clearance, reduce exacerbations, and improve the quality of life. These treatment include not only drugs and respiratory physiotherapy, but also surgery. However, despite advances in thoracic surgery, this strategy is still controversial as a therapeutic approach for bronchiectasis, but no quantitative systematic review was ever performed to assess the efficiency and safety of surgical resection for the management of non-CF bronchiectasis.

Now, researchers conducted a meta-analysis to determine the effects of surgical intervention in patients with non-CF bronchiectasis. To this end, the team searched for studies in PubMed, the Cochrane library and Web of Science databases using the following terms: “surgery” or “operative” or “resection”, “bronchiectasis” or “NCFB” or “non-CF bronchiectasis”. In total, 38 studies were included in the meta-analysis, accounting for a total of 5,541 participants.

The meta-analysis revealed that the operative morbidity and mortality were 16.7% and 1.5%, respectively, indicating that surgery intervention carries an acceptable risk for patients with non-CF bronchiectasis. This fact was further demonstrated by follow-up studies, with lung resection surgery rendering 66.5% of patients to become asymptomatic and 27.5% with alleviated symptoms. Researchers believe that removing the diseased lung harboring persistent infection and inflammation is beneficial for the adjacent healthy lung tissue and also can halt disease progression. Another study reported a similar result, where symptomatic non-CF bronchiectasis patients improved their quality of life (including exercise capacity) after resection of lung-damaged areas. A percentage of 9.1% of patients, however, showed no improvement or worsening of the condition. These patients were identified as those with symptoms for longer than five years, but they could still benefit from the surgical treatment. Moreover, when comparing adults with children, the team observed a small increase in morbidity among adults, most likely as a consequence of more comorbidity, such as diabetes and heart disease.

In conclusion, the team highlighted that the findings support surgery intervention as an efficacious strategy for non-CF bronchiectasis, associated with a low risk of mortality and acceptable morbidity rates. Researchers propose that patients who fail to respond to other types of treatment should be considered for surgical therapy.

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