Image characteristics as predictors for thoracoscopic anatomic lung resection in patients with pulmonary tuberculosis

A variety of complications occur in patients with pulmonary tuberculosis. The feasibility of a thoracoscopic approach to anatomic lung resection for the complications of mycobacterial infection has not been well evaluated.

We retrospectively analyzed chest computed tomography (CT) scans of patients who underwent anatomic lung resections without additional procedures for tuberculosis between January 2007 and September 2009. Image characteristics on chest CT scans were classified as bullae, pleural thickening, peribronchial lymph node calcification, tuberculoma, cavity, aspergilloma, atelectasis, and bronchiectasis, and graded according to the number of the lesions and degree of lobar involvement. Patients were divided into two groups, video-assisted thoracoscopic surgery (VATS) and thoracotomy for anatomic lung surgery, according to the eventual operative procedure. The variables between these two groups were compared using the Student t test; the image characteristics were compared using a χ2 test.

Fifty patients were enrolled; 21 given VATS and 29 given a thoracotomy. The VATS group had significantly lower gradings in pleural thickening, peribronchial lymph node calcification, tuberculoma, cavity, and aspergilloma than did the thoracotomy group (p=0.000, 0.015, 0.001, 0.023, and 0.022, respectively). Mean operative time, blood loss, and complication rate were not significantly different, but the mean hospital stay was significantly shorter (10.00 days versus 14.96 days, p=0.048) in the VATS group.

Multiple cavities, multiple aspergillomas, multilobar tuberculoma, extensive pleural thickening, and peribronchial lymph node calcification preclude VATS. It is reasonable to attempt a thoracoscopic approach in patients without these preoperative image characteristics.