BRONCHIECTASIS - INDICATIONS AND OPTIMAL TIMING FOR SURGERY

Despite continuous improvement in the medical treatment of bronchiecta sis, a number of patients will eventually require surgery. The optimal timing of surgical resection and the efficacy of surgery need to be r eassessed in this context. The records of 85 patients operated for bro nchiectasis during the period 1971-1991 were reviewed. Six patients un derwent repeated surgical resections. Long term results could be asses sed in 73 patients (86 %) by means of questionnaire or subsequent medi cal evaluation. Indications for surgery were: persistent symptoms unde r medical treat ment in 43 cases (51 %), local complications such as f ungal superinfection or severe bleeding in 17 (20 %) and 11 (13 %) res pectively, pulmonary mass lesions in 14 (16%). Limited resections such as segmentectomies or lobectomies were carried out in 79 cases (93 %) . In patients with localized disease (N = 49), surgery led to signific ant improvement in 91 % of cases. in patients with extensive or compli cated disease (N = 36), long term results of surgery were satisfactory in 62 % and poor in 38 %; surgery was often more aggressive in this g roup of patients (5 pneumonectomies), and 4 postoperative deaths occur red (in debilitated patients). Patients with localized disease and rec curent symptoms despite medical treatment should be operated before th e development of complications. At this stage, surgical resection can be limited and has the potential to cure or significantly improve thei r condition. In contrast, patients with extensive disease are often de bilitated and surgical treatment is less rewarding and sometimes poorl y tolerated.