The Present Status of Thoracic Surgery in Tuberculosis

¹ Department of Thoracic Surgery, Postgraduate Medical School, Pontificia Universidade Católica do Rio de Janeiro

A review of 861 pulmonary resections for tuberculosis, performed from 1951 to 1965 has shown the following overall results, according to the bacteriologic data:

1. In 330 negative sputum patients, there were three bronchopleural fistulae (0.9 per cent), 15 pleural empyemata (3.6 per cent), ten relapses (3.0 per cent), 21 operative deaths (6.5 per cent), two late deaths (0.6 per cent) and 295 discharges as good results to follow-up (89.4 per cent).

2. In 428 chronic patients with positive sputum operated upon without effective chemotherapy, there were 48 bronchopleural fistulae (10.2 per cent), 31 pleural empyemata (7.2 per cent), 73 relapses (17.0 per cent), 35 operative deaths (8.2 per cent), 42 late deaths (9.8 per cent) and 321 discharges as good results to follow-up (75.0 per cent).

3. In 103 positive sputum chronic patients operated upon under effective secondary drug coverage, there was no bronchopleural fistula, no pleural empyema, four relapses (3.9 per cent), two operative deaths (1.9 per cent), no late death and 99 discharges as good results to follow-up (96.0 per cent).

These figures show the importance of bacteriologic factors in prognosis of thoracic surgery for tuberculosis. Second line drugs actually protect surgery by means of preand postoperative control of bacillary activity, providing over 90.0 per cent of good results. Such significant reward is far beyond the recovery rates obtained either by surgery alone or by autonomous secondary chemotherapy.