BRONCHIECTASIS - INDICATIONS AND OPTIMAL TIMING FOR SURGERY

Despite continuous improvement in the medical treatment of bronchiectasis, a number of patients will eventually require surgery. The optimal timing of surgical resection and the efficacy of surgery need to be reassessed in this context. The records of 85 patients operated for bronchiectasis during the period 1971-1991 were reviewed. Six patients underwent repeated surgical resections. Long term results could be assessed in 73 patients (86 %) by means of questionnaire or subsequent medical evaluation. Indications for surgery were: persistent symptoms under medical treat ment in 43 cases (51 %), local complications such as fungal superinfection or severe bleeding in 17 (20 %) and 11 (13 %) respectively, 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 significant improvement in 91 % of cases. in patients with extensive or complicated disease (N = 36), long term results of surgery were satisfactory in 62 % and poor in 38 %; surgery was often more aggressive in this group of patients (5 pneumonectomies), and 4 postoperative deaths occurred (in debilitated patients). Patients with localized disease and reccurent symptoms despite medical treatment should be operated before the development of complications. At this stage, surgical resection can be limited and has the potential to cure or significantly improve their condition. In contrast, patients with extensive disease are often debilitated and surgical treatment is less rewarding and sometimes poorly tolerated.