The safety and efficacy of decortication for stage III drug-resistant tuberculous empyema

Li Yao; Bing Wang; Xianxiang Chen; Qibin Liu; Jian Sheng; Xiaoyu Liu; Xiyong Dai; Yuhui Jiang

doi:10.1093/icvts/ivad166

The safety and efficacy of decortication for stage III drug-resistant tuberculous empyema

Interdiscip Cardiovasc Thorac Surg. 2023 Nov 2;37(5):ivad166. doi: 10.1093/icvts/ivad166.

Authors

Li Yao¹, Bing Wang¹, Xianxiang Chen¹, Qibin Liu¹, Jian Sheng¹, Xiaoyu Liu¹, Xiyong Dai¹, Yuhui Jiang¹

Affiliation

¹ Department of Surgery, Wuhan Pulmonary Hospital, 28, Baofeng Road, Qiaokou District, Wuhan, Hubei Province, 430000, China.

Abstract

Objectives: The goal of this study was to evaluate the safety and efficacy of decortication for stage III drug-resistant tuberculous empyema (TE).

Methods: We analysed all patients with stage III TE who underwent decortication between March 2015 and October 2019 at Wuhan Pulmonary Hospital. The patients were divided into 2 groups according to drug-susceptibility testing of bronchoscopy lavage fluid, pleural effusion and tissue specimens, including a drug-resistant group and a drug-sensitive group. We collected and compared the preoperative, perioperative and postoperative data from the 2 groups to evaluate the safety and efficacy of decortication for stage III drug-resistant TE.

Results: In total, 135 cases met the inclusion criteria and were enrolled, including 30 cases in the drug-resistant group and 105 cases in the drug-sensitive group. No deaths were recorded for the entire study population. Compared to the drug-sensitive group, the drug-resistant group had longer operation times (259.8 ± 78.4 min vs 187.2 ± 56.0 min, P = 0.00), a larger volume of intraoperative blood loss [300 (200,400) ml vs 200 (130, 300) ml, P = 0.00] and a higher intraoperative transfusion rate (5/30, 16.7% vs 4/105, 3.8%, P = 0.04). The rate of complications was significantly higher in the drug-resistant group (23; 76.7%) than in the drug-sensitive group (53; 50.5%) (P = 0.01). Recurrence was not reported in any of the patients. Twenty-three (76.7%) patients in the drug-resistant group and 90 (85.7%) patients in the drug-sensitive group recovered to an "excellent" level, and 3 cases in each group recovered to a "poor" level; there was no significant difference between the 2 groups in surgical effects (P = 0.21).

Conclusions: Decortication is a safe, effective and feasible option for patients with stage III drug-resistant TE, although the operation is difficult and risky.

Keywords: Surgery; Treatment outcomes; Tuberculous empyema; drug-resistant tuberculosis.