Surgical treatment of patients with a combined forms of pulmonary tuberculosis and lung cancer

Abstract

Objective — to improve surgical treatment of patients with combined forms of pulmonary tuberculosis and non small cell lung cancer due to minimally invasive diagnostics and with the use of sterno-mediastinal surgical dissection of tissue and complete systematic bilateral lymph node dissection (CSBLND). Materials and methods. Our studies involved retrospective analysis of 101 cases of treatment of patients with stage I—II—IIIА non-small cell lung cancer (NSCLC) and pulmonary tuberculosis. A review of diagnostics and operations over the past decade were conducted. All patients underwent surgical treatment. The main group included 48 patients who underwent 16 lobectomy and 32 pneumonectomy from the sternomediastinal access. A comparative analysis of the effectiveness of the CSBLND was carried out. The comparison group included 53 patients who underwent 17 lobectomy and 36 pneumonectomy, a surgical operation for lateral thoracotomy and selective dissection of the mediastinal lymph nodes was performed. Results and discussion. The analysis of the morphological features of combined forms of pulmonary tuberculosis and NSCLC has been made in comparison groups, that were explored retrospectively. There was a trend improved survival patients combined forms of pulmonary tuberculosis and NSCLC stage I—II—IIIA, who underwent of CSBLND (p = 0.05). A statistically significant of survival of patients who underwent pneumonectomy in the mail group (n = 32) with CSBLND (p = 0.01). In a comparative analysis of the frequency and nature of complications during surgery, we found out that in general in the main group they met in 2.1 times less often than in the comparison group (p < 0.05). Complications during operation in patients of the main group occurred in (11.4 ± 2.6) %, while in the comparison group — in (22.6 ± 4.2) % of cases. The analysis of data showed that patients with adenocarcinoma of lung cancer have been improvements in the performance of sterno-mediastinal surgical techniques (CSBLND) (p = 0.12). Therefore, patients with combined forms of pulmonary tuberculosis and NSCLC for suspected «jumping metastases» we recommended to carry out operations with sternotomy surgical access with full system bilateral lymph nodes dissection and radical rezection of pathologically altered lung. All this requires further development of high-tech surgical techniques in our country. Conclusions. The leading effect of pulmonary tuberculosis on the surgical treatment of patients with combined forms of tuberculosis and lung cancer has been shown in groups of comparison. The increase of 3 years survival in patients of basic groups is set, demonstrating the advantage of active diagnostical surgical tactics of stage I—II—IIIА NSCLC with used sterno-mediastinal access and the appliance of more radical CSBLND. Thus, the clinical effect of operative patients of the main groups in the immediate postoperative period was reached 95.7 % patients, in the groups comparison clinical effect be noted in 80.5 %.