Decision-making for lung resection in patients with empyema and collapsed lung due to tuberculosis

Collapsed lung with associated empyema is a different clinical entity from destroyed lung . A low perfusion rate of the diseased lung is usually considered an indication for pneumonectomy in patients undergoing thoracotomy for tuberculosis. Such a criterion may not adequately reflect the functional capacity of the underlying parenchyma when the lung is collapsed.

One hundred twenty-seven patients underwent thoracotomy for tuberculosis at our hospital between 1998 and 2003. Among these, 5 (4%) patients who had a collapsed lung for more than 3 months and pleural infection were the subjects of this study. Surgery was considered after at least a 3-month course of regular antituberculous treatment. Despite no perfusions in 2 patients and 8%, 10%, and 15% perfusion rates for the remaining 3 patients, decortication alone was intentionally performed, and any kind of resectional operation was avoided.

The lung gradually filled the hemithorax between 5 and 12 days after surgery in 4 patients. The remaining patient required a thoracomyoplasty 8 weeks after the initial operation. Repeated perfusion scans 1 and 2 years after decortication continued to show no perfusion in patients who had had no preoperative perfusion. All patients were symptom free on regular follow-up between 10 months and 4.5 years.

It seems that the outcome is unpredictable in terms of lung expansion after decortication, which is a relatively simple procedure compared with other surgical options. We think that the risk of rethoracotomy is acceptable, considering the devastating complications and high mortality rates of resectional surgery in the treatment of such patients.