Efficacy and safety of pneumonectomy in the comprehensive treatment of patients with destructive pulmonary tuberculosis

Abstract

Introduction. Despite significant progress in the fight against pulmonary tuberculosis, surgical methods of treatment are still in demand all over the world. The pro- portion of pneumonectomy in various clinics varies from 9.8 to 32%, and the incidence of postoperative complications and mortality remain at a fairly high level.

Objective. Substantiation of the effectiveness and safety of pneumonectomy in the complex treatment of patients with destructive pulmonary tuberculosis.

Materials and methods. A retrospective study was conducted from 2010 to 2019. In accordance with the inclusion and exclusion criteria, 198 patients were included into the study. The clinical and radiological data and features of the course of tuberculosis, functional parameters, characteristics of surgical interventions, intraoperative and postoperative complications were studied. Postoperative complications were assessed using the TM&M classification. The risk factors were selected using correlation and logistic regression analysis. Survival analysis was carried out using Kaplan-Meier method. Factors influencing the recurrence of tuberculosis and mortality in the longterm period were chosen using Cox regression analysis. The value of p<0.05 was considered significant.

Results. Complications in the early postoperative period developed in 94 (47.5%) patients. In their structure, minor complications occurred in 41 (43.6%) cases, major complications occurred in 53 (56.4%). Surgical complications developed in 29 (14.6%) cases. A satisfactory immediate result of treatment was recorded in 181 (91.4%) patients, unsatisfactory — in 13 (6.6%), 4 (2%) patients died. The long-term outcome was studied in 146 (75.2%) patients. Among them, a successful result of treatment was achieved in 129 (88.3%) patients, ineffective treatment — in 9 (6.2%). 8 (5.5%) patients died. Among patients who successfully completed the course of treatment, 10 (7.7%) had a relapse of tuberculosis. Among them, 6 (60%) patients managed to achieve a successful result of treatment, the remaining 4 (40%) patients died. Survival at one year was 97.9%, 3- and 5-year survival rates were 97.2 and 89.4%, respectively.

Conclusion. The early and long-term outcomes present- ed by the authors demonstrate high efficiency and safety of pneumonectomy in the comprehensive treatment of patients with destructive pulmonary tuberculosis.