[Risk management of surgery for infectious lung disease]

Although pulmonary resection can be performed with low operative morbidity and mortality in patients with lung cancer, surgery for infectious lung disease still carries high postoperative complication rates. Major complications include massive intraoperative blood loss, bronchopleural fistula, empyema, and post-resectional space. One of the keys to reduce the complication rates is that patients should be kept on chemotherapy for at least 3 months prior to operation. Other keys are the following. First, painstaking extrapleural dissection is recommended to dissect dense adhesion in order to reduce blood loss and to prevent the operative field being contaminated. Second, the bronchial stump should be covered with muscle flap to prevent bronchopleural fistula. Third, when the post-resectional space is anticipated, myoplasty or thoracoplasty should be performed to reduce the size of space. Finally, patients should continue to be on chemotherapy after the surgery for the prevention of relapse.