Impact of Delayed Video-Assisted Thoracoscopic Surgery on Pneumonectomy Outcomes in Patients with Tuberculosis

Objective: To investigate the impact of delayed video-assisted thoracoscopic surgery (VATS) on the rate of postoperative complications and tuberculosis recurrence following pneumonectomy.

Materials and methods: A retrospective, open, cohort, nonrandomized, multicenter study conducted between 1984 and 2022 included 815 patients with destructive pulmonary tuberculosis who underwent pneumonectomy with delayed VATS thoracoplasty (group 1, 214 patients) or without it (group 2, 601 patients). Both groups were further divided into 3 subgroups based on multislice computed tomography findings of the remaining lung condition: А, no pathology; Б, foci or tuberculoma without cavitation; В, cavitation (CV+).

Results: In group 1, postoperative complications occurred in 7 patients (3.27%); there was no hospital mortality, and the short-term effectiveness of the surgery was 95.79% (205 patients). In group 2, these parameters were 28.95%, 7.49%, and 85.36%, respectively. In group 1, the effectiveness at 1, 3, and 5 years after discharge was 98.54%, 95.51%, and 93.20%, respectively; 32 (15.53%) patients had recurrence or progression of tuberculosis. Eight patients (3.88%) died from tuberculosis, and 11 (5.24%) experienced late bronchopleural complications. The 5-year survival rate for group 1 was 93.96%. The long-term outcomes in group 2 were worse. The effectiveness at 1, 3, and 5 years was 91.33%, 89.81%, and 87.28%, respectively. Recurrence or progression of tuberculosis was observed in 74 patients (18.88%); 34 patients died from tuberculosis (8.67%), and 42 patients had late bronchopleural complications (10.71%). The 5-year survival rate was 85.52%.

Conclusions: Delayed VATS thoracoplasty significantly improves both short-term and long-term outcomes of pneumonectomy in patients with tuberculosis, especially in case of a destructive process affecting the remaining lung.

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