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Surgery for lung abscess in immunocompetent and immunocompromised children
1Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republiuc of China.
Insights
Surgical management of pediatric lung abscesses differs between immunocompetent and immunocompromised children. More extensive surgery is recommended for immunocompromised patients, yielding excellent results despite underlying disease complexity.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Infectious Diseases
Background:
- Lung abscess and necrotizing pneumonia in children often require surgical intervention when medical treatment fails.
- Drug-resistant bacteria and fungal infections are increasingly contributing to the need for surgery.
Purpose of the Study:
- To evaluate and compare the surgical management outcomes of lung abscess in pediatric patients, stratified by immune status (immunocompetent vs. immunocompromised).
Main Methods:
- A 12-year retrospective analysis of 30 children (23 immunocompetent, 7 immunocompromised) undergoing surgery for lung abscess or necrotizing pneumonia.
- Surgical procedures included pulmonary resection (unilateral, bilateral, or lobectomy) and decortication.
Main Results:
- Immunocompromised children often presented with multi-lobe involvement and required more extensive pulmonary resections.
- Bacterial abscesses were more common in younger children, while fungal abscesses occurred in adolescents, with a predilection for the left lung.
- Postoperative morbidity was 10.2% with no mortality; average hospital stay was 18.4 days.
Conclusions:
- Significant differences exist in the incidence and presentation of surgically managed lung abscesses between immunocompetent and immunocompromised children.
- Aggressive and extensive surgical approaches are beneficial for immunocompromised children, achieving excellent outcomes.
- Prognosis in immunocompromised children is closely linked to their underlying medical conditions.
Purpose:
The aim of this study was to evaluate the surgical management results of lung abscess in immunocompetent and immunocompromised children.
Methods:
Surgery was performed on 30 children with lung abscess or necrotizing pneumonia refractory to medical treatment in a 12-year period. Of them, 23 were immunocompetent, and 7 were immunocompromised. Pulmonary resection was performed including unilateral lung in 28, bilateral in 2, and 2 lobes in 6. Concomitant decortication was performed in 18 (78.2%) immunocompetent patients.
Results:
Increased incidence of surgery for lung abscess was caused mainly by drug-resistant and fungal infection. Surgery was performed commonly for bacterial lung abscess on patients less than 5 years old and fungal lung abscess on adolescence. A multiple small abscess was the predominant type of abscess in immunocompetent patients, whereas 2-lobe involvement tended to occur in immunocompromised patients. Fungal lung abscess tended to occur on left lung and in female patients. Left lower lobe was involved most commonly in both groups of patients in which majority need lobectomy. Immunocompromised patients required a more extensive pulmonary resection. There were 3 postoperative complications (morbidity of 10.2%) with no postoperative mortality. Length of postoperative hospital stay ranged from 6 to 85 days with average of 18.4 days.
Conclusions:
The incidence and pattern of lung abscess that required surgery between immunocompetent and immunocompromised children were different. A more aggressive, extensive surgical procedure is preferable for immunocompromised patients, and the surgical results were comparatively excellent to immunocompetent patients. However, the prognosis of immunocompromised children depends on their underlying disease process.