Staged surgical treatment of patients with bilateral pulmonary tuberculosis with indications for pneumonectomy

Abstract

Objective. To improve treatment effectiveness in patients with bilateral pulmonary tuberculosis and indications for pneumonectomy. Material and methods. A retrospective analysis enrolled 25 patients who underwent surgery between 2012 and 2025. All patients underwent staged surgical treatment, including pneumonectomy and surgery on the contralateral lung. Patients were divided into two groups: group 1 (n=12) — pneumonectomy combined with lung resection; group 2 (n=13) — pneumonectomy combined with collapse surgery (predominantly extrapleural pneumonolysis with silicone implant placement). Results. Pneumonectomy at the first stage was often a forced measure due to urgent indications or the need to eliminate the main reservoir of infection. In elective cases, less traumatic interventions were preferable at the first stage. In the 1st group, postoperative complication rate was significantly higher (p<0.05) compared to the 2nd group without 30-day complications. There was no in-hospital mortality. The five-year survival rate after all surgical stages was 89% and 67% in both groups, respectively. The main cause of long-term mortality was progression of tuberculosis. Conclusion. Resection of the less affected lung is preferable at the first stage if functional reserves are normal. Collapse surgery is indicated in patients with low reserves. Collapse surgery demonstrates higher safety in immediate postoperative period. Adherence to treatment is a key factor for long-term success.