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. 2014 Sep;6(9):1173-9.
doi: 10.3978/j.issn.2072-1439.2014.08.30.

Wedge resection for localized infectious lesions: high margin/lesion ratio guaranteed operational safety

Yifeng Sun  1 , Likun Hou  1 , Huikang Xie  1 , Hui Zheng  1 , Gening Jiang  1 , Wen Gao  1 , Chang Chen  1
Affiliations

Wedge resection for localized infectious lesions: high margin/lesion ratio guaranteed operational safety

Yifeng Sun et al. J Thorac Dis. 2014 Sep.

Abstract

Objective: This study aims to elucidate the risk factors of pulmonary complications for localized infectious lesions with limited resection.

Methods: We retrospectively investigated 139 cases for which wedge resection had been performed for localized pulmonary infectious lesions. Patients included 85 males and 54 females with a median age of 53 years (range: 21-74 years old). Forty-six patients had focal organizing pneumonia (OP), sixty patients had lung abscess, twenty-three patients had aspergilloma, five patients had lung abscess combining aspergillus fumigatus, and five patients had lung abscess combined with tuberculosis granuloma. Information regarding perioperative manipulations, surgical complications, and follow-ups were collected for further analysis.

Results: Prominent pneumonia developed in eight cases post-operation. In follow-up, one patient had a recurrence of lung abscess five months post-operation and underwent a left upper lobectomy and one patient died two months after discharge because of respiratory failure that resulted from pneumonia. Univariate and multivariate analysis showed a significant difference in the margin/lesion ratio (distance between staple margins to lesion/the maximum tumor diameter) between patients with pulmonary complications and those without complications (P=0.01). The best cut-off value of margin/lesion ratio to complication was 0.985, and a margin/lesion ratio less than 0.985 was associated with high post-operative complications.

Conclusions: The present case series shows that partial resection for localized pulmonary infection is an acceptable surgical manipulation. A high margin/lesion ratio achievement may guarantee operational safety.

Keywords: Wedge resection; complication; infectious lesions; lung; operation.

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Figures

Figure 1
Figure 1
CT scanning and HE staining of focal organization pneumonia, aspergilloma and lung abscess. (A) Focal organization pneumonia. Upper: CT images of focal organization pneumonia. Low: alveolar spaces are filled with fibromyxoid plugs. Interstitial thickening with chronic inflammatory cells infiltrating are also evident (HE staining, 100×); (B) lung abscess. Upper: CT images of lung abscess. Low: suppuative necrosis with surrounding fibrosis was present in HE staining slides (100×); (C) aspergilloma. Upper: CT images of aspergilloma. Low: aspergillus within bronchiole was visible (100×).
Figure 2
Figure 2
The way to calculate the distance of lesion centre to the lobe-orifice. The center of the lesion as one point at the lobe- orifice level with the help of an axis of coordinate using the CT scanning computer and measured the distance point to the lobe-orifice (lobe where the lesion was located) as D1; the distance between the cross section of the center of the lesion to the cross section of the lobe orifice was considered as D2; the formula D=D12+D22 was used to deduce the distance of lesion centre to the lobe-orifice.
Figure 3
Figure 3
ROC Curve of margin/lesion ratio. The best cut-off to margin/lesion ratio that maximizes (sensitivity + specificity) is 0.985. At this point, the sensitivity is 0.64 and specificity is 1 (1-specificity =0). AUC, area under roc curve.
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