A clinical research team, reviewing 20 years of lung surgery as a treatment option for bronchiectasis, reported excellent outcomes in a majority of patients to indicate that surgery remains a viable option in select bronchiectasis cases. The study, “Surgical treatment of bronchiectasis: A review of 20 years of experience,“ was published in the Portuguese Journal of Pulmonology.
Surgical treatment of bronchiectasis is usually given only to patients whose localized disease is no longer responding to drug treatment. Parts of the lung that are irreversibly damaged have poor penetrance of antibiotics, and can serve as a protective niche for microorganisms, allowing the spread of recurrent infections. Surgery using pulmonary resection — the removal of a part of the lung — is often an alternative in these patients.
To explore the role of lung surgery in bronchiectasis, the research team at the Centro Hospitalar de Vila Nova de Gaia e Espinho, Portugal, reviewed all cases of lung surgery for bronchiectasis performed at the hospital between 1994 and 2014.
Prior to surgery, the most frequent symptoms reported were recurring infections, affecting 56.5 percent of the patients, and the presence of a persistent productive cough, affecting 47.8 percent.
Over the 20 years 69 patients underwent surgery, of which about half, 44.9 percent, were male. Most patients (47.8 percent) had surgery because drug therapy failed to improve their disease. Coughing blood was also a common reason, at 31.9 percent, while a non-diagnostic lung mass and a lung abscess affected 13 percent and 7.3 percent, respectively.
Surgical procedures varied between the removal of a segment of one lung, removal of one lobe, and the removal of one entire lung. Lobe removal was by far the most frequent method used, in 65.2 percent. None of the patients had a two-sided surgery because of the known risks of this procedure.
No patient deaths were reported after the surgery, but 14.5 percent had post-surgical complications, such as persistent air leaks or bleeding that required a repeat surgery.
Follow-up, which involved 87 percent of the patients, was done after at least one year, and found that the vast majority of the patients (73.3 percent) rated their current health status as excellent compared to before the surgery. Another 18.3 percent rated it as improved, while 8.3 percent stated their health was unchanged.
Most patients (73.9 percent) were operated on during the first decade of the study period, a fact the authors think mirrors a perceived decline in bronchiectasis in developing countries. Still, the good outcomes of surgery showed that the procedure is remains an important approach to improving the health and quality of life for certain bronchiectasis patients.