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Department of Surgery, Union Memorial Hospital, Ste 610, J. P. B. 3333 N Calvert St, Baltimore, MD 21218-2895
(Email: richard.heitmiller{at}medstar.net).
In this study Zhang and colleagues [1] present their experience in the surgical management of patients with localized, noncystic fibrosis-related bronchiectasis. This is a very large retrospective review including 790 patients during a 20-year time span. The authors describe the indications for surgery, operative techniques, and results. Notably, they report respectable postoperative morbidity and mortality rates of 16.2% and 1.1%, respectively.
The authors highlight the features of current preoperative, operative, and postoperative management in several areas. The diagnosis of bronchiectasis is now most commonly made by chest computed tomography instead of bronchography. Indications for surgery include localized disease, a symptomatic patient, and failure of nonsurgical treatments. At surgery, bronchial flap coverage and aggressive pleural space drainage minimizes stump leak, bronchovascular fistula, and empyema, respectively. Prompt and complete clearance of postoperative respiratory secretions minimizes the incidence of pneumonia. The authors believe that all of these factors contribute to their good results.
Whereas the lessons learned from the work-up and management of this large number of patients is important, the intriguing side message from this article is the dramatic increase in the prevalence of patients with localized bronchiectasis in China since 2001, and the fact is that this trend is apparently being observed globally as well. Whether this finding is due to aging populations, poverty, lack of access to healthcare or medications, acquired bacterial antibiotic resistance, immunosuppressive diseases, the resurgence of tuberculosis, or other factors is not clear. However, one factor that is clear is the current resurgence of bronchiectasis in many areas of the world. First described more than 190 years ago, clinical interest in bronchiectasis peaked in the early days of open thoracic surgery, prior to the widespread introduction of antibiotics, when the frequency of surgical cases was high. The prevalence of bronchiectasis is believed to have declined since that time; this is no longer true, which makes this study and its lessons learned all the more relevant.
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