Video-assisted thoracoscopic lung resection in tuberculosis treatment: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DING Chao , LIU Yugang , WEI Lin , GU Zhenning ,  ZHU Changsheng

Department of Thoracic Surgery, Xi’an Chest Hospital, Xi’an, 710100, P.R.China;

Corresponding?author：

ZHU Changsheng, Email: zhuchangshengdr@hotmail.com

Keywords：

Video-assisted thoracoscopic surgery; tuberculosis; surgery

DOI：

10.7507/1007-4848.201809038

Video：

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Objective To investigate the feasibility of video-assisted thoracoscopic surgery (VATS) lung resection in the treatment of tuberculosis.Methods We retrospectively analyzed the clinical data of 164 tuberculosis patients who underwent lung resection in Xi'an Chest Hospital from 2013 to 2017. Patients were divided into two groups according to the surgical procedure: a VATS group (85 patients, 56 males and29 females) and a thoracotomy group (79 patients, 52 males and 27 females). The clinical effect of the two groups was compared.Results Compared to the thoracotomy group, the VATS group had less operation time (151.59±76.75 min vs. 233.48±93.89 min, P<0.001), amount of intraoperative blood loss (200.00 ml vs. 600.00 ml, P<0.001), the postoperative drainage (575.00 ml vs. 1 110.00 ml, P=0.001), extubation time (4 d vs. 6 d, P<0.001) and hospital stay (13.00 d vs. 17.00 d, P<0.001). There was no statistical difference in postoperative complications (10 patients vs.17 patients, P=0.092) between the two groups. A total of 97 patients underwent lobectomy, including 36 of the VATS group and 61 of the thoracotomy group. The operation time (211.39±70.88 min vs. 258.20±87.16 min, P=0.008), the intraoperative blood loss (400.00 ml vs. 700 ml, P<0.010), the postoperative drainage (800.00 ml vs. 1 250.00 ml, P=0.001), extubation time (5.00 d vs. 8.00 d, P=0.002) and hospital stay (13.11±4.45 d vs. 19.46±7.74 d, P<0.010) in the VATS group were significantly better than those in the thoracotomy group. There was no statistical difference in postoperative complication rate (4 patients vs. 14 patients, P=0.147) between the two^[1], groups.Conclusion Compared with conventional thoracotomy, VATS lung resection has obvious advantages in treatment of tuberculosis, which may be the preferred technique.

Citation： DING Chao, LIU Yugang, WEI Lin, GU Zhenning, ZHU Changsheng. Video-assisted thoracoscopic lung resection in tuberculosis treatment: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(7): 653-659. doi: 10.7507/1007-4848.201809038 Copy

1.	Paul S, Altorki NK, Sheng S, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg, 2010, 139(2): 366-378.
2.	Yen YT, Wu MH, Lai WW, et al. The role of video-assisted thoracoscopic surgery in therapeutic lung resection for pulmonary tuberculosis. Ann Thorac Surg, 2013, 95(1): 257-263.
3.	Tseng YL, Chang JM, Liu YS, et al. The role of video-assisted thoracoscopic therapeutic resection for medically failed pulmonary tuberculosis. Medicine(Baltimore), 2016, 95(18): e3511.
4.	車勇, 常煒, 劉志剛, 等. 電視胸腔鏡治療肺結核臨床療效分析. 新疆醫學, 2017, 47(6): 585-588.
5.	唐神結, 高文. 臨床結核病學. 人民衛生出版社, 2011. 356.
6.	WHO. Guidelines for the programmatic management of drug-resistant tuberculosis, 2011 Update. WHO/HTM/TB/ 20116. 2011. Geneva: World Health Organization; 2011.
7.	趙豐曾. 肺結核外科適應癥 (草案). 中國防癆雜志, 1985, 7(4).
8.	肺結核手術適應證標準 (試行方案). 肺結核手術適應證標準 (試行方案). 中華結核和呼吸雜志, 1994, 17(2): 73.
9.	Jacobs JP, Mavroudis C, Jacobs ML, et al. What is operative mortality? Defining death in a surgical registry database: A report of the STS Congenital Database Taskforce and the Joint EACTS-STS Congenital Database Committee. Ann Thorac Surg, 2006, 81(5): 1937-1941.
10.	Odell JA. The history of surgery for pulmonary tuberculosis. Thorac Surg Clin, 2012, 22(3): 257-269.
11.	嚴碧涯. 肺結核治療的進展. 中國防癆雜志, 1981, 3, (2): 1-8.
12.	劉鴻翹. 肺結核外科療法國內研究近況. 中國防癆雜志, 1988, 10(1): 44-45.
13.	金鋒. 堅定不移地推進肺結核手術適應證的修訂——熱烈祝賀"首屆結核外科建設與手術適應證研討會"勝利召開. 中國防癆雜志, 2017, 39(9): 916-925.
14.	Kempker RR, Rabin AS, Nikolaishvili K, et al. Additional drug resistance in mycobacterium tuberculosis isolates from resected cavities among patients with multidrug-resistant or extensively drug-resistant pulmonary tuberculosis. Clin Infect Dis, 2012, 54(6): e51.
15.	Dartois V, Barry CE. Clinical pharmacology and lesion penetrating properties of second- and third-line antituberculous agents used in the management of multidrug-resistant (MDR) and extensively-drug resistant (XDR) tuberculosis. Curr Clin Pharmacol, 2010, 5(2): 96-114.
16.	Park SK, Kim JH, Kang H, et al. Pulmonary resection combined with isoniazid- and rifampin-based drug therapy for patients with multidrug-resistant and extensively drug-resistant tuberculosis. Int J Infect Dis, 2009, 13(2): 170-175.
17.	Vashakidze S, Gogishvili S, Nikolaishvili K, et al. Favorable outcomes for multi- and extensively drug resistant tuberculosis patients undergoing surgery. Ann Thorac Surg, 2013, 95(6): 1892.
18.	Sihoe AD. The current role of thoracic surgery in tuberculosis management. Respirology, 2009, 14(7): 954-968.
19.	Takeda S, Maeda H, Hayakawa M, et al. Current surgical intervention for pulmonary tuberculosis. Ann Thorac Surg, 2005, 79(3): 959-963.
20.	Falzon D, Schünemann HJ, Harausz E, et al. World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update. Eur Respir J, 2017, 49(3): 1602308.
21.	劉倫旭. 開胸手術將逐漸" 升級”為胸腔鏡微創手術的補充. 中國胸心血管外科臨床雜志, 2012, 19(2): 109-112.
22.	周逸鳴, 張雷, 宋楠, 等. 電視胸腔鏡肺切除術治療肺結核 815 例分析. 中國防癆雜志, 2017, 39(5): 448-451.
23.	劉倫旭, 車國衛, 蒲強, 等. 單向式全胸腔鏡肺葉切除術. 中華胸心血管外科雜志, 2008, 24(3): 156-158.
24.	Vadim G, Pischik. Technical difficulties and extending the indications for VATS lobectomy. J Thorac Dis, 2014, 6(Suppl 6): S623-S630.
25.	Pezzella AT, Fang W. Surgical aspects of thoracic tuberculosis: a contemporary review--part 1. Curr Probl Surg, 2008, 45(10): 675.
26.	唐神結, 高文, 主編. 臨床結核病學. 人民衛生出版社, 2011. 260.
27.	Pomerantz M, Madsen L, Goble M, et al. Surgical management of resistant mycobacterial tuberculosis and other mycobacterial pulmonary infections. Ann Thorac Surg, 1991, 52(5): 1108.
28.	Fadel E, Missenard G, Chapelier A, et al. En bloc resection of non-small cell lung cancer invading the thoracic inlet and intervertebral foramina. J Thorac Cardiovasc Surg, 2002, 123(4): 676-685.
29.	胡汶斌, 袁順達, 俞幼林, 等. 胸腔鏡輔助小切口與傳統開胸手術治療結核性毀損肺效果比較. 中華結核和呼吸雜志, 2016, 39(2): 143-144.
30.	王成, 張運曾, 金鋒. 胸腔鏡輔助小切口在結核性毀損肺葉切除術中的應用. 中國防癆雜志, 2017, 39(5): 445-447.
31.	Kempker RR, Vashakidze S, Solomonia N, et al. Surgical treatment of drug-resistant tuberculosis. Lancet Infect Dis, 2012, 12(2): 157-166.
32.	Shiraishi Y, Katsuragi N, Kita H, et al. Aggressive surgical treatment of multidrug-resistant tuberculosis. J Thorac Cardiovasc Surg, 2009, 138(5): 1180.
33.	Mohsen T, Zeid AA, Hajyahia S. Lobectomy or pneumonectomy for multidrug-resistant pulmonary tuberculosis can be performed with acceptable morbidity and mortality: a seven-year review of a single institution's experience. J Thorac Cardiovasc Surg, 2007, 134(1): 194-198.
34.	Wang H, Lin H, Jiang G, et al. Pulmonary resection in the treatment of multidrug-resistant tuberculosis: a retrospective study of 56 patients. Ann Thorac Surg, 2008, 86(5): 1640-1645.
35.	Kang MW, Kim HK, Choi YS, et al. Surgical treatment for multidrug-resistant and extensive drug-resistant tuberculosis. Ann Thorac Surg, 2010, 89(5): 1597-1602.

1. Paul S, Altorki NK, Sheng S, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg, 2010, 139(2): 366-378.
2. Yen YT, Wu MH, Lai WW, et al. The role of video-assisted thoracoscopic surgery in therapeutic lung resection for pulmonary tuberculosis. Ann Thorac Surg, 2013, 95(1): 257-263.
3. Tseng YL, Chang JM, Liu YS, et al. The role of video-assisted thoracoscopic therapeutic resection for medically failed pulmonary tuberculosis. Medicine(Baltimore), 2016, 95(18): e3511.
4. 車勇, 常煒, 劉志剛, 等. 電視胸腔鏡治療肺結核臨床療效分析. 新疆醫學, 2017, 47(6): 585-588.
5. 唐神結, 高文. 臨床結核病學. 人民衛生出版社, 2011. 356.
6. WHO. Guidelines for the programmatic management of drug-resistant tuberculosis, 2011 Update. WHO/HTM/TB/ 20116. 2011. Geneva: World Health Organization; 2011.
7. 趙豐曾. 肺結核外科適應癥 (草案). 中國防癆雜志, 1985, 7(4).
8. 肺結核手術適應證標準 (試行方案). 肺結核手術適應證標準 (試行方案). 中華結核和呼吸雜志, 1994, 17(2): 73.
9. Jacobs JP, Mavroudis C, Jacobs ML, et al. What is operative mortality? Defining death in a surgical registry database: A report of the STS Congenital Database Taskforce and the Joint EACTS-STS Congenital Database Committee. Ann Thorac Surg, 2006, 81(5): 1937-1941.
10. Odell JA. The history of surgery for pulmonary tuberculosis. Thorac Surg Clin, 2012, 22(3): 257-269.
11. 嚴碧涯. 肺結核治療的進展. 中國防癆雜志, 1981, 3, (2): 1-8.
12. 劉鴻翹. 肺結核外科療法國內研究近況. 中國防癆雜志, 1988, 10(1): 44-45.
13. 金鋒. 堅定不移地推進肺結核手術適應證的修訂——熱烈祝賀"首屆結核外科建設與手術適應證研討會"勝利召開. 中國防癆雜志, 2017, 39(9): 916-925.
14. Kempker RR, Rabin AS, Nikolaishvili K, et al. Additional drug resistance in mycobacterium tuberculosis isolates from resected cavities among patients with multidrug-resistant or extensively drug-resistant pulmonary tuberculosis. Clin Infect Dis, 2012, 54(6): e51.
15. Dartois V, Barry CE. Clinical pharmacology and lesion penetrating properties of second- and third-line antituberculous agents used in the management of multidrug-resistant (MDR) and extensively-drug resistant (XDR) tuberculosis. Curr Clin Pharmacol, 2010, 5(2): 96-114.
16. Park SK, Kim JH, Kang H, et al. Pulmonary resection combined with isoniazid- and rifampin-based drug therapy for patients with multidrug-resistant and extensively drug-resistant tuberculosis. Int J Infect Dis, 2009, 13(2): 170-175.
17. Vashakidze S, Gogishvili S, Nikolaishvili K, et al. Favorable outcomes for multi- and extensively drug resistant tuberculosis patients undergoing surgery. Ann Thorac Surg, 2013, 95(6): 1892.
18. Sihoe AD. The current role of thoracic surgery in tuberculosis management. Respirology, 2009, 14(7): 954-968.
19. Takeda S, Maeda H, Hayakawa M, et al. Current surgical intervention for pulmonary tuberculosis. Ann Thorac Surg, 2005, 79(3): 959-963.
20. Falzon D, Schünemann HJ, Harausz E, et al. World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update. Eur Respir J, 2017, 49(3): 1602308.
21. 劉倫旭. 開胸手術將逐漸" 升級”為胸腔鏡微創手術的補充. 中國胸心血管外科臨床雜志, 2012, 19(2): 109-112.
22. 周逸鳴, 張雷, 宋楠, 等. 電視胸腔鏡肺切除術治療肺結核 815 例分析. 中國防癆雜志, 2017, 39(5): 448-451.
23. 劉倫旭, 車國衛, 蒲強, 等. 單向式全胸腔鏡肺葉切除術. 中華胸心血管外科雜志, 2008, 24(3): 156-158.
24. Vadim G, Pischik. Technical difficulties and extending the indications for VATS lobectomy. J Thorac Dis, 2014, 6(Suppl 6): S623-S630.
25. Pezzella AT, Fang W. Surgical aspects of thoracic tuberculosis: a contemporary review--part 1. Curr Probl Surg, 2008, 45(10): 675.
26. 唐神結, 高文, 主編. 臨床結核病學. 人民衛生出版社, 2011. 260.
27. Pomerantz M, Madsen L, Goble M, et al. Surgical management of resistant mycobacterial tuberculosis and other mycobacterial pulmonary infections. Ann Thorac Surg, 1991, 52(5): 1108.
28. Fadel E, Missenard G, Chapelier A, et al. En bloc resection of non-small cell lung cancer invading the thoracic inlet and intervertebral foramina. J Thorac Cardiovasc Surg, 2002, 123(4): 676-685.
29. 胡汶斌, 袁順達, 俞幼林, 等. 胸腔鏡輔助小切口與傳統開胸手術治療結核性毀損肺效果比較. 中華結核和呼吸雜志, 2016, 39(2): 143-144.
30. 王成, 張運曾, 金鋒. 胸腔鏡輔助小切口在結核性毀損肺葉切除術中的應用. 中國防癆雜志, 2017, 39(5): 445-447.
31. Kempker RR, Vashakidze S, Solomonia N, et al. Surgical treatment of drug-resistant tuberculosis. Lancet Infect Dis, 2012, 12(2): 157-166.
32. Shiraishi Y, Katsuragi N, Kita H, et al. Aggressive surgical treatment of multidrug-resistant tuberculosis. J Thorac Cardiovasc Surg, 2009, 138(5): 1180.
33. Mohsen T, Zeid AA, Hajyahia S. Lobectomy or pneumonectomy for multidrug-resistant pulmonary tuberculosis can be performed with acceptable morbidity and mortality: a seven-year review of a single institution's experience. J Thorac Cardiovasc Surg, 2007, 134(1): 194-198.
34. Wang H, Lin H, Jiang G, et al. Pulmonary resection in the treatment of multidrug-resistant tuberculosis: a retrospective study of 56 patients. Ann Thorac Surg, 2008, 86(5): 1640-1645.
35. Kang MW, Kim HK, Choi YS, et al. Surgical treatment for multidrug-resistant and extensive drug-resistant tuberculosis. Ann Thorac Surg, 2010, 89(5): 1597-1602.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Video-assisted thoracoscopic lung resection in tuberculosis treatment: A retrospective cohort study

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