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Mintairov, James L. Merz and Steven A. Blundell",authors:[{id:"101544",title:"Dr.",name:"Alexander",middleName:null,surname:"Mintairov",fullName:"Alexander Mintairov",slug:"alexander-mintairov"},{id:"103335",title:"Prof.",name:"James",middleName:null,surname:"Merz",fullName:"James Merz",slug:"james-merz"},{id:"103337",title:"Dr.",name:"Steven",middleName:null,surname:"Blundell",fullName:"Steven Blundell",slug:"steven-blundell"}]},{id:"37470",title:"InAs Quantum Dots in Symmetric InGaAs/GaAs Quantum Wells",slug:"inas-quantum-dots-in-symmetric-ingaas-gaas-quantum-wells",signatures:"Tetyana V. Torchynska",authors:[{id:"39831",title:"Prof.",name:"Tetyana",middleName:null,surname:"Torchynska",fullName:"Tetyana Torchynska",slug:"tetyana-torchynska"}]},{id:"37471",title:"Photoionization Cross Sections of Atomic Impurities in Spherical Quantum Dots",slug:"photoionization-cross-sections-of-atomic-impurities-in-spherical-quantum-dots",signatures:"C.Y. Lin and Y.K. Ho",authors:[{id:"107370",title:"Dr.",name:"Yew Kam",middleName:null,surname:"Ho",fullName:"Yew Kam Ho",slug:"yew-kam-ho"},{id:"107742",title:"Dr.",name:"Chih-Yuan",middleName:null,surname:"Lin",fullName:"Chih-Yuan Lin",slug:"chih-yuan-lin"}]},{id:"37472",title:"Exciton States in Free-Standing and Embedded Semiconductor Nanocrystals",slug:"exciton-states-in-free-standing-and-embedded-semiconductor-nanocrystals",signatures:"Yuriel Núñez Fernández, Mikhail I. Vasilevskiy, Erick M. Larramendi and Carlos Trallero-Giner",authors:[{id:"109335",title:"Prof.",name:"Mikhail",middleName:null,surname:"Vasilevskiy",fullName:"Mikhail Vasilevskiy",slug:"mikhail-vasilevskiy"},{id:"140406",title:"MSc.",name:"Yuriel",middleName:null,surname:"Núñez Fernández",fullName:"Yuriel Núñez Fernández",slug:"yuriel-nunez-fernandez"},{id:"140407",title:"Dr.",name:"Erick",middleName:"Milton",surname:"Larramendi",fullName:"Erick Larramendi",slug:"erick-larramendi"},{id:"140408",title:"Prof.",name:"Carlos",middleName:null,surname:"Trallero-Giner",fullName:"Carlos Trallero-Giner",slug:"carlos-trallero-giner"}]},{id:"37473",title:"In-Gap State of Lead Chalcogenides Quantum Dots",slug:"in-gap-state-of-3-lead-chalcogenides-quantum-dots",signatures:"Xiaomei Jiang",authors:[{id:"108233",title:"Dr",name:null,middleName:null,surname:"Jiang",fullName:"Jiang",slug:"jiang"}]},{id:"37474",title:"Exciton Dynamics in High Density Quantum Dot Ensembles",slug:"optical-characteristics-of-high-density-quantum-dot",signatures:"Osamu Kojima",authors:[{id:"102153",title:"Prof.",name:"Osamu",middleName:null,surname:"Kojima",fullName:"Osamu Kojima",slug:"osamu-kojima"}]},{id:"37475",title:"Electron Transport Properties of Gate-Defined GaAs/AlxGa1-xAs Quantum Dot",slug:"electron-transport-properties-of-gate-defined-gaas-alxga1-xas-quantum-dot",signatures:"Dong Ho Wu and Bernard R. Matis",authors:[{id:"99271",title:"Dr.",name:"Dong Ho",middleName:null,surname:"Wu",fullName:"Dong Ho Wu",slug:"dong-ho-wu"}]},{id:"37476",title:"Tunneling Atomic Force Microscopy of Self-Assembled In(Ga)As/GaAs Quantum Dots and Rings and of GeSi/Si(001) Nanoislands",slug:"tunneling-atomic-force-microscopy-of-self-assembled-in-ga-as-gaas-quantum-dots-and-rings-and-of-",signatures:"Dmitry Filatov, Vladimir Shengurov, Niyaz Nurgazizov, Pavel Borodin and Anastas Bukharaev",authors:[{id:"19492",title:"Dr.",name:"Dmitri",middleName:null,surname:"Filatov",fullName:"Dmitri Filatov",slug:"dmitri-filatov"},{id:"108153",title:"MSc.",name:"Pavel",middleName:null,surname:"Borodin",fullName:"Pavel Borodin",slug:"pavel-borodin"},{id:"108154",title:"Prof.",name:"Anastas",middleName:null,surname:"Bukharaev",fullName:"Anastas Bukharaev",slug:"anastas-bukharaev"},{id:"108156",title:"Prof.",name:"Vladimir",middleName:null,surname:"Shengurov",fullName:"Vladimir Shengurov",slug:"vladimir-shengurov"},{id:"138546",title:"Dr.",name:"Niyaz",middleName:null,surname:"Nurgazizov",fullName:"Niyaz Nurgazizov",slug:"niyaz-nurgazizov"}]},{id:"37477",title:"Quantum Injection Dots",slug:"quantum-injection-dots",signatures:"Eliade Stefanescu",authors:[{id:"105272",title:"Prof.",name:"Eliade",middleName:"N.",surname:"Stefanescu",fullName:"Eliade Stefanescu",slug:"eliade-stefanescu"}]},{id:"37478",title:"Quantum Mechanics of Semiconductor Quantum Dots and Rings",slug:"quantum-mechanics-of-semiconductor-quantum-dots-and-rings",signatures:"I. Filikhin, S.G. Matinyan and B. Vlahovic",authors:[{id:"105361",title:"Dr",name:"Igor",middleName:null,surname:"Filikhin",fullName:"Igor Filikhin",slug:"igor-filikhin"},{id:"109479",title:"Prof.",name:"Sergei",middleName:null,surname:"Matinyan",fullName:"Sergei Matinyan",slug:"sergei-matinyan"},{id:"109480",title:"Prof.",name:"Branislav",middleName:null,surname:"Vlahovic",fullName:"Branislav Vlahovic",slug:"branislav-vlahovic"}]},{id:"37479",title:"Non-Equilibrium Green Functions of Electrons in Single-Level Quantum Dots at Finite Temperature",slug:"non-equilibrium-green-functions-at-finite-temperature-of-electron-in-single-level-quantum-dots",signatures:"Nguyen Bich Ha",authors:[{id:"105909",title:"Dr",name:null,middleName:null,surname:"Ha",fullName:"Ha",slug:"ha"}]},{id:"37480",title:"Electron Scattering Through a Quantum Dot",slug:"electron-scattering-through-a-quantum-dot",signatures:"Leonardo Kleber Castelano, Guo-Qiang Hai and Mu-Tao Lee",authors:[{id:"107805",title:"Prof.",name:"Guo-Qiang",middleName:null,surname:"Hai",fullName:"Guo-Qiang Hai",slug:"guo-qiang-hai"},{id:"109512",title:"Prof.",name:"Leonardo",middleName:null,surname:"Castelano",fullName:"Leonardo Castelano",slug:"leonardo-castelano"},{id:"109513",title:"Prof.",name:"Mu-Tao",middleName:null,surname:"Lee",fullName:"Mu-Tao Lee",slug:"mu-tao-lee"}]},{id:"37481",title:"Coherent Spin Dependent Transport in QD-DTJ Systems",slug:"coherent-spin-dependent-transport-in-quantum-dot-systems",signatures:"Minjie Ma, Mansoor Bin Abdul Jalil and Seng Ghee Tan",authors:[{id:"40388",title:"Prof.",name:"Seng Ghee",middleName:null,surname:"Tan",fullName:"Seng Ghee Tan",slug:"seng-ghee-tan"},{id:"40392",title:"Dr.",name:"Mansoor B.A.",middleName:null,surname:"Jalil",fullName:"Mansoor B.A. Jalil",slug:"mansoor-b.a.-jalil"},{id:"126727",title:"Dr.",name:"Minjie",middleName:null,surname:"Ma",fullName:"Minjie Ma",slug:"minjie-ma"}]},{id:"37482",title:"The Thermopower of a Quantum Dot Coupled to Luttinger Liquid System",slug:"photon-assisted-transport-through-a-quantum-dot-coupled-to-low-dimension-system",signatures:"Kai-Hua Yang, Yang Chen, Huai-YuWang and Yan-JuWu",authors:[{id:"102175",title:"Dr.",name:"Kai-Hua",middleName:null,surname:"Yang",fullName:"Kai-Hua Yang",slug:"kai-hua-yang"}]}]}]},onlineFirst:{chapter:{type:"chapter",id:"72982",title:"Surgical Management of Bronchiectasis",doi:"10.5772/intechopen.93103",slug:"surgical-management-of-bronchiectasis",body:'\n
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1. Introduction
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Bronchiectasis was originally described by René Laënnec in 1819. This term comes from two Greek words; “Bronkhia” and “Ektasis” meaning “Airway widening”. As a medical term, bronchiectasis refers to chronic lung disease associated with irreversible dilatation of the bronchial tree. For many years, it was considered as an orphan disease; however, the detection of bronchiectasis has been increased in the recent years as a result of increased health awareness and modern advances in the imaging techniques [1, 2].
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The prevalence of bronchiectasis varies in relation to geographic location. The estimated prevalence of bronchiectasis in developed countries (USA, UK, Germany, Spain) is up to 566 cases per 100,000, with 40% increase in the past decade [3, 4]. The recent findings from the British lung foundation’s project showed that around 212,000 people are currently living with bronchiectasis in the UK, with predominence of female gender and over-70 age [5]. In USA, 252,362 patients were indentified with an average annual prevalence of 701 per 100,000 persons between 2006 and 2014, with mean age of 76 years, predominace of female gender (65%), and dual diagnosis of chronic obstructive pulmonary disease (COPD) in most of the patients (51%) [6]. In China, the overall prevalence of physician-diagnosed bronchiectasis in people aged 40 years or older is estimated at 1.2% and is trending upward with aging of the population [7]. In comparison to European estimates, the recently reported patients with bronchiectasis in India were younger (median age of 56 years), more likely to be men, and showed a high frequency of severe, cystic bronchiectasis. Tuberculosis and other severe infections were the most frequently reported underlying cause [8].
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Most of the cases of bronchiectasis are idiopathic in etiology, however, it may be found in a variety of pulmonary diseases, genetic or acquired, such as cystic fibrosis (CF), Kartagener syndrome (triad of situs inversus, chronic sinusitis, and bronchiectasis), COPD, alpha 1-antitrypsin deficiency, bronchial asthma, or primary immunodeficiencies [9, 10]. In the absence of CF, particularly with post-infectious and allergic hypersensitivity causes, the disease is known as non-cystic fibrosis bronchiectasis (NCFB) [10].
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The pathogenesis of bronchiectasis is based on the “vicious cycle hypothesis” which begins by infectious or noninfectious insult to the lung, resulting in neutrophil inflammation (proteases) and impairment of the mucociliary clearance followed by microbial colonization or infection, bronchial obstruction, and exaggerated inflammatory response. The “vicious cycle” (Figure 1) refers to the occurrence of repeated infections with repeated impairment of the mucociliary apparatus subsequent to infection and inflammation [10, 11, 12].
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Figure 1.
Vicious cycle of bronchiectasis.
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The clinical diagnosis of bronchiectasis is challenging as it manifests early non-specific symptoms and signs. However, the presence of chronic cough with overproduction of sputum which may worse at the morning increases the index of suspicion for bronchiectasis especially in non-smokers [13, 14]. Other significant signs of bronchiectasis include: hemoptysis, chronic respiratory failure, pulmonary hypertension, and right-sided heart failure [13].
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Bronchiectasis can be classified anatomically (cylindrical, varicoid, or cystic), and radiologically (localized or diffuse) [14]. Chest radiographs show non-specific findings of bronchiectasis such as: atelectatic changes, and hyperinflation [13, 14]. High-resolution computed tomography (HRCT) of the chest is a useful imaging tool for diagnosis of bronchiectasis and detection of the underlying causes. On HRCT, bronchiectatic changes include dilated airways, thick-walled bronchi with failed tapering at the periphery of the lung,, ring opacity, tram-track sign, and finger-in-glove sign, and signet-ring sign when the dilated bronchi is larger than the companion pulmonary artery branch (Bronchial-to-arterial ratio > 1) [14].
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A bundle of minimum etiological tests has been recommended by European Respiratory Society (ERS) for newly diagnosed patients with bronchiectasis including: differential blood count, immunoglobulins (IgA, IgM and IgG), and allergic bronchopulmonary aspergillosis (ABPA)-specific tests (total IgE, specific IgE to Aspergillus, IgG to Aspergillus and eosinophil count), in addition to sputum culture for monitoring of bacterial and non-tuberculous infections [15].
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Etiology-specific investigations include: Sweat chloride assessment and cystic fibrosis transmembrane conductance regulator (CFTR) genetic analysis for cystic fibrosis, serum alpha1-antitrypsin level and phenotyping for Alpha-1-antitrypsin deficiency, measurement of nasal nitric oxide levels and ciliated epithelial biopsy for primary ciliary dyskinesia, Rheumatoid factor and anti-cyclic citrullinated peptide (CCP) for autoimmune/connective tissue diseases, and specific CT findings of congenital malformations including Williams-Campbell syndrome (bronchomalacia); Mounier-Kuhn syndrome (tracheobronchomegaly) and lung sequestration [16].
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Bronchoscopy is not a routine diagnostic tool for bronchiectasis in the era of HRCT, but there are several indications for diagnostic bronchoscopy in such cases including: exclusion of foreign body obstruction especially in children, exclusion of proximal obstruction in adults with localized disease, obtaining microbiological results in acute ill patients, sampling of lower respiratory tract secretions when serial sputum testing did not yield results, obtaining endobronchial biopsy of airway cilia, and localizing the site of bleeding in patients with bronchiectasis and hemoptysis [17].
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The age-adjusted mortality rate for both male and female patients with diagnosed bronchiectasis is more than twice the mortality in the general population [4]. The independent risk factors influencing long-term mortality (over 13 years) in patients with bronchiectasis include: age, St George’s Respiratory Questionnaire activity score, Pseudomonas aeruginosa infection, total lung capacity (TLC), residual volume/TLC, and the transfer factor coefficient [18]. Therefore, in order to reduce the suspected poor prognosis with bronchiectasis, the treatment should be directed to improve symptoms, enhance quality of life, reduce exacerbations, and limit progression of the bronchiectatic lesions [15, 19].
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Treatment of bronchiectasis has been considered by ERS guidelines according to the vicious cycle hypothesis [15]. Thus, the options of treatment include: long-term inhaled or oral antibiotic therapy, eradication of new pathogenic microorganisms and antibiotic treatment of exacerbations for chronic bronchial infection, long-term anti-inflammatory therapies for inflammation, long-term mucoactive treatments and airway clearance techniques for impaired mucociliary clearance, and long-term bronchodilator therapy, surgery and pulmonary rehabilitation for structural lung disease.
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2. Indications of surgery
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Optimization of the medical management and proper selection of patients are crucial in the decesion making for surgery. Therefore, the current guidelines by ERS and British Thoracic Society (BTS) did not consider surgery until the symptoms are controlled by optimized medical treatment [15, 20]. The indications of surgery as recently mentioned by BTS guideline (Figure 2) include: persistent symptoms despite up to a year of comprehensive medical treatment, exacerbations that are either severe or frequent and interfere with social/professional life, recurrent refractory or massive hemoptysis, post obstruction bronchiectasis distal to tumors, localized severely damaged lobe/segment that may be a source of sepsis that left in situ may lead to extension of lung damage, and treatment of complications such as empyema or lung abscess [20].
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Figure 2.
Current indications for surgical treatment of bronchiectasis [15, 20].
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Up to date, there are only 46 published studies in literature between 1960 and 2019, evaluating the surgical management of bronchiectasis [21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66]. The most common clinical manifestations in these studies were: productive cough in 17.4–100% [54, 57], fetid sputum in 15.1–80% [35, 57], and hemoptysis in 10–76.5% [44, 59], while the main and indications of surgery include: failure of medical therapy in 39.6–100% [43, 50], recurrent chest infection in 19.8–100% [23, 54], massive or recurrent hemoptysis in 3–44.3% [32, 43], lung abscess in 1.8–36.5% [32, 58], lung masses or tumors in 1.4–17.6% [42, 46], and empyema in 1.1–8.1% [30, 57]. The mean duration of symptoms before surgery ranged from 1.78–10.6 years [30, 66].
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Failure of prudent medical treatment is the main indication of surgery in these studies, especially with frequent exacerbations and repeated hospitalizations [41]. Some authors considered failure of treatment if sputum production persists after 2 or 3 cycles of treatment [35]. The permanently damaged areas of bronchiectasis have poor antibiotic penetration leading to failure of antibiotic therapy, and acts as a microbiological reservoir with subsequent recurrence of infection [61]. Moreover, medical treatment for long periods with persistent symptoms has additional psychological and social effects [32].
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Therefore, surgery after failed medical treatment should aim to improve clinical condition and health-related quality of life, in addition to resolution of terrible bronchiectasis-related complications. This aim can be achieved when the focal lesions are completely removed, however, patients with multisegmental lesions should have palliative limited resection after failure of medical treatment or in the presence of life-threatening hemoptysis [47].
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Recurrence of pulmonary infection is an important indication of surgery, as it can result in increased cost and side effects of antibiotic therapy for acute infection, in addition to affection of the normal lung tissue with extension of lung destruction during each episode [32]. When bronchiectasis is associated with lung abscess, surgery should be delayed until adequate control with antibiotic therapy and avoiding of preoperative drainage is recommended, however, the immediate indications of surgery in the presence of lung abscess include increased abscess size, unceasing sepsis, and contralateral contamination [30].
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Recurrent or massive hemoptysis of more than 600 mL of blood within 24 hours indicates surgery which is considered as emergency after failure of the conservative therapy for hemoptysis. Even after initial cessation of bleeding by balloon blockade of the bleeding bronchus or bronchial artery embolization, early surgical treatment is indicated to avoid life-threatening recurrence of hemoptysis [30].
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In children, the indications for surgery are the same as in adult patients. Growth retardation can be considered as an additional indication for surgery in children with satisfactory postoperative results [43]. It is crucial to exclude the underlying diseases such as Kartagener syndrome and cystic fibrosis which limit the surgical resection [36].
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3. Preoperative evaluation
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Preoperative evaluation should include physical examination, imaging studies, arterial blood gases, pulmonary function tests, bronchoscopy, and perfusion scans if indicated. Additional diagnostic work-up may be required for patients with cardiovascular diseases including echocardiography, stress testing, myocardial perfusion studies, and coronary angiography [48].
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3.1 Chest radiography
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Chest radiography represents non-specific features of bronchiectasis with low sensitivity and difficult appreciation. The suggestive findings in moderate to severe patients include: stranding, cystic lesions, volume loss with crowding of vessels, atelectasis, tram-track appearance, ring-like opacities, and tubular densities [28, 67]. Despite inadequate role of chest radiography in evaluation of bronchiectasis, abnormalities on chest radiography is significantly correlated with severity of the disease on HRCT [68].
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3.2 High resolution computed tomography (HRCT)
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The images of HRCT have higher sensitivity for diagnosis and localization of bronchiectasis than radiography with very low false negative and false positive results [41, 69]. The indications of HRCT include: clinical suspicion despite normal chest radiography, clarification of abnormalities on chest radiography, and decision making for surgery [70]. The use of HRCT is not restricted by age of the patient, thus HRCT is not uncommon diagnostic tool in children with bronchiectasis [56].
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In addition to the great help of HRCT in diagnosis of different types of bronchiectasis (Figure 3), preoperative localization of the lesions by HRCT has specific importance in making the decision for complete anatomic resection or limited resection with preservation of the lung tissue [30].
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Figure 3.
Images of high resolution computed tomography show types of bronchiectasis: (A) cylindrical, (B) varicose, and (C) cystic.
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3.3 Bronchoscopy
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Bronchoscopy should be performed in all patients to determine the underlying causes of bronchial obstruction including: foreign body aspiration, endobronchial epithelial tumors, and enlarged hilar lymph nodes with lobar collapse [30, 36]. Preoperative removal of the secretions and clearing of the airways is an important indication of bronchoscopy in adult and children patients [63], as it is associated with lower rate of postoperative complications [41].
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3.4 Pulmonary function tests
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Pulmonary function tests (PFTs) are not routinely performed in cases of bronchiectasis when the lesions are localized, but PFTs should be performed in diffuse bronchiectasis and in cases of repeated operations [36]. Pulmonary function tests can be performed in adult patients or in children older than 6 years of age [59]; however, cooperation of the child may affect completeness of the pulmonary function tests [35].
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The patients with bronchiectasis may have obstructive ventilatory pattern related to mucus retention or immunological abnormalities. The surgical resection of pulmonary segments with little contribution to ventilatory process is expected to have no or minimal effect on postoperative pulmonary function [31]. The expected loss of pulmonary function after surgical resection of bronchiectasis can be calculated from the equation: expected loss of function = preoperative function * (number of functional segments in the lobe to be resected/total number of segments of both lungs) [53].
Ventilation/perfusion (V/Q) scintigraphy provides information about hemodynamic features (vascular perfusion), gas exchange, and quantitative lung function, which has a particular help in cases with diffuse bronchiectasis as it can determine the most affected non-perfused areas to be surgically resected [36, 37]. The affected area is considered non-perfused when the perfusion is <10% of the expected [37]. Moreover, V/Q scintigraphy is indicated in patients with poor pulmonary function to provide more quantitative information about ventilation function [38].
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Some authors tried to find the correlation between morphologic type of bronchiectasis and the hemodynamic perfusion features. The study by Ashour in 1996, determined a correlation of cylindric morphology with pulmonary perfusion, contrary to non-perfusion predominance in cystic type, thus the surgery for diffuse bronchiectasis can be reserved for non-perfused cystic lesions which are more damaged than cylindrical lesions [71]. Thereafter, Al-Kattan and colleagues reported a new hemodynamic classification of bronchiectasis in patients with diffuse or bilateral disease, combining the perfusion and morphologic features to provide a reasonable extent of surgery and to obtain maximum postoperative clinical improvement [37].
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4. Preoperative preparation
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The preoperative preparation of patients with bronchiectasis should aim to provide the best possible status. Therefore, the preoperative preparation should be performed by a multidisciplinary team consists of infectious disease specialists, pulmonologists, and thoracic surgeons [72].
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4.1 Sputum culture analysis
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The patients should have appropriate preoperative preparation until the sputum volume reduced to 20-50 mL per day [54, 63], or the antibiotic therapy is modified according to new culture sensitivity results of the sputum [63]. As the gram-negative bacterial infection has a significant risk for perioperative complications, surgery should be performed after negative proof of Gram-negative bacillus on sputum culture analysis [58].
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In patients with a history of tuberculosis, surgery should be reserved for patients with inactive disease. Some surgeons postponed elective surgery 6 months if the sputum culture was positive for acid-fast bacilli and after the completion of antituberculosis treatment [41].
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4.2 Infection control
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Preoperatively, patients should be hospitalized and prepared for at least 2 weeks before surgery [48]. The patients who are scheduled for surgery should have no active pulmonary infection at the time of surgery. Therefore, broadspectrum antibiotics should be given for 48 hours prior to surgery, or prophylactic antibiotics are given according to results of sputum culture and sensitivity tests [36, 54]. For prophylaxis, cephalosporin and aminoglycoside are preferred if the culture is negative and the patient has no contraindications or allergies [48].
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4.3 Chest physiotherapy and postural drainage
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The patients should have intensive chest physiotherapy in the preoperative period, to obtain acceptable decrease of the daily volume of the sputum [54]. Patients should have chest physiotherapy including postural drainage for at least 2 weeks bfore surgery [57], or it should be continued until the daily sputum is ≤50 mL [50]. Preoperative postural drainage is essential to clean intra-tracheal secretions, decrease the sputum volume and sputum accumulation, and hence control of the infection and optimize the respiratory status [50, 58].
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The recommended airway clearance techniques are active breathing techniques or oscillating positive expiratory pressure (PEP). Review of HRCT findings is helpful to determine the appropriate postural drainage in relevance to the affected pulmonary segments. The gravity assisted positioning, where not contraindicated, is recommended to enhance the effectiveness of an airway clearance technique. Modified postural drainage without head down tilt should be considered when the postural drainage is not tolerated and when the symptoms of gastroesophageal reflux increased with the technique [17, 20].
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4.4 Other considerations
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Nutritional support and pulmonary rehabilitation should be considered before surgical referral [20]. In patients on long-term steroid therapy, the doses may be increased by 5–10 mg/day, but surgery should be postponed in patients with uncontrolled respiratory symptoms [72].
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5. Surgical procedures
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5.1 Thoracotomy
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The anesthetic management during surgery for bronchiectasis should consider: (1) cleaning of the bronchus opposite to the side of surgery by aspiration before placement of endotracheal tube, and (2) avoiding contralateral contamination by: insertion of double-lumen endotracheal tube, use of Fogarty embolectomy catheter as a bronchus blocker, or advancing of the endotracheal tube to the main bronchus of the opposite side of resection [35, 37, 41, 54, 57].
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Posterolateral thoracotomy is the standard approach for pulmonary resection in patients with bronchiectasis. Preservation of the integrity of chest wall muscles using muscle-sparing technique is essential to reduce postoperative pain and generate an effective cough [29]. When the decision is for bilateral lung resection, the second operation can be performed with an interval of 1–4 months [49, 53].
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The extent of lung resection is determined by extent of the disease and cardiopulmonary reserve, thus lobectomy is performed for lesions limited to one lobe, segmentectomy is performed for fairly limited disease or when the pulmonary function is impaired, while pneumonectomy is reserved for extensive disease affecting the whole lung [33, 50, 54]. In some instances, bilobectomy and lobectomy plus segmentectomy can be performed [40, 44, 48, 50, 52, 61]. Extrapleural dissection is preferred to avoid spillage of lung content into pleural space. After identification of the hilar structures and opening of the major fissure, arterial, venous, and bronchial branches are isolated and divided, respectively [39, 63].
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Certain recommendations can be followed to prevent or reduce the incidences of postoperative air leak and bronchopleural fistula (BPF) after lung resection including: preservation of peribronchial tissues and avoidance of extensive lymph node dissection near to bronchi to minimize bronchial devascularization, division of the bronchus before mobilization of the resected part to avoid contamination of the healthy segments, division of the bronchial stump as short as possible which sutured by non-absorbable materials or closed with a mechanical stapler then buttressed by tissue glue or a flap from pleura, pericardium, pericardial fat pad, muscle, or omentum [41, 73].
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To reduce the extension of contamination during surgery, extrapleural intrapericardial pneumonectomy is recommended when there is pleural sepsis or complete fusion of the pleura. Also, the evidence of pleural infection indicates pleural space irrigation with antibiotic [73]. Following placement of the chest drains, bronchoscopic evaluation of the bronchial sutures with removal of any secretions in the airway should be performed [63]. The resected specimens should be sent for histopathological examination [41].
\n
\n
\n
5.2 Video-assisted thoracoscopic surgery (VATS)
\n
There is a little research work regarding use of VATS in the management of bronchiectasis. The reported VATS approaches for lobectomy in patients with bronchiectasis include three ports, two ports, or one port VATS [55, 62, 66]. Additionally, a two-port thoracoscopy with a utility mini-thoracotomy has been reported [45].
\n
For three ports completely VATS procedure, the ports are placed through the 7th or 8th intercostal space in the midaxillary line for a 10-mm 30° thoracoscope, the 4th or 5th intercostal space along the anterior axillary line (4–5 cm incision), and the 7th or 8th intercostal space in the auscultatory triangle (1.5 cm incision) [55]. For two ports VATS lobectomy, a 2 cm camera port through the 7th or 8th intercostal space in the anterior axillary line and a 3–5 cm utility incision through the 4th or 5th intercostal space in the anterior or mid axillary line [62]. Ocakcioglu et al. described uniportal VATS lobectomy through a utility incision of 3–5 cm from the 5th intercostal space in the anterior position without use of rib retractor. A 10 mm 30° thoracoscope is placed in the anterior part of the incision, while dissecting and holding clamps are placed through the dorsal part [66].
\n
During 3 ports VATS, the incisions change depending on the type of lung resection, whether it is an upper or lower lobectomy [62]. The presence of intrathoracic adhesions is a challenging problem during VATS which can be released by blunt or sharp dissection, or it may result in conversion of the VATS procedure to open procedure [55, 64]. As in open thoracotomy, the pulmonary artery is firstly identified and divided before the division of the veins to avoid congestion of the lobe, with separate dissection of the major pulmonary veins and the bronchus [64]. The dissection of vascular and airway structures is performed by an endoscopic linear cutter [55]. At the end of VATS procedure, the thorax is closed after retrieval of the resected specimens and meticulous control of air leak and hemorrhage [66].
\n
\n
\n
5.3 Postoperative care
\n
Bronchoscopy can be performed in the operating room for bronchial hygiene, immediately after surgery [56]. The early postoperative care should include: pain control including epidural analgesia, chest physiotherapy, antibiotic therapy according to results of culture and sensitivity [37, 56].
\n
Generally, the duration of postoperative systematic antibiotic therapy is 5 days, but it can be longer according to the inflammatory condition. Early ambulation and active cough, and 3–4 times percussive chest physiotherapy are essential for proper expectoration and lung re-expansion. The standard criteria for removal of chest tube are: stable vital signs, small amount of drainage (<100 mL/day) with clear color, lung re-expansion on chest X-ray, and absence of air leak [63].
\n
After discharge, patients should have specific or wide-spectrum antibiotic therapy for 1 week. Chest physiotherapy can be reinitiated at home and continued for 2 weeks after discharge [33].
\n
\n
\n
\n
6. Postoperative outcomes of lung resection
\n
\n
6.1 Mortality
\n
To date, few studies have evaluated postoperative outcomes after lung resection for bronchiectasis (Table 1). There is no perioperative mortality (early, operative, in-hospital, postoperative, or 30-days) after surgical resection of bronchiectasis in most of the published studies. The reported rates of perioperative mortality ranged from 0.41% [23] to 8.3% [25]. The causes of early mortality in literature include: respiratory failure [2, 27, 28, 41, 49, 57], intraoperative bleeding [24, 28, 46], postoperative pneumonia [25, 37], empyema [25, 32], pulmonary edema [27, 46], cardiac-related causes including myocardial infarction or arrhythmia [27, 35, 47, 49, 58], speptic shock [27, 56], gastrointestinal bleeding due to sepsis and stress ulcer [39], uncontrolled hemoptysis [27], pulmonary embolism [22, 32, 48, 58], cardiac arrest in patients with Kartagener syndrome [36], disseminated intravascular coagulation [44], nephropathy [22], downstream consequences of bronchial stump fistula [48, 60], multiple organ failure [48, 60], and causes unrelated to disease or technique such as cerebral edema in a child due to previously undiagnosed aquaeductus stenosis and hydrocephalus [24]. The disease-related consequences which indirectly attribute to early death include: severe disease requiring pneumonectomy or completion [28, 58], massive bleeding during the operation because of dense adhesions due to chronic and recurrent infections [44, 46], and Kartagener syndrome [36].
The rates of late or long-term mortality ranged from 0.41% [27] to 8.3% [25]. The reported causes of late mortality after surgical management of bronchiectasis included: respiratory failure [24, 52], progressive respiratory disease [25], sepsis [59], coronary artery thrombosis [22], cor pulmonale or pulmonary heart disease [22, 58], myocardial failure [22], glomerulonephritis [22], kidney failure [58], post-pneumonectomy pneumonia in the remaining lung [56], massive bleeding from the Malecot catheter used for drainage ofresidual space infection [44], suicide [22], and other causes of late deaths not attributable to bronchiectasis [21, 23, 26].
\n
\n
\n
6.2 Morbidity
\n
The reported rates of morbidity ranged from 7% [7] to 38% [39]. The most common complication is atelectasis or sputum retention requiring bronchoscopic intervention, followed by persistent air leak (Table 2). Most of the reported complications were minor, transient, and treatable.
Reported rates of complications after surgical treatment of bronchiectasis.
\n
In comparison to the published studies in the 3rd and 4th decades of 20th century, the relatively low incidences of complication in the after while studies can reflect effective antibiotic therapy, improved anesthetic techniques, adequate blood transfusion, and detailed postoperative care [21, 22]. Other factors include: surgeon’s experience, preoperative awareness of the undesirable consequences of retained secretions, preoperative teaching of breathing exercises, scheduling tracheal suction or bronchoscopy in the early postoperative period [21], good intraoperative hemostasis and careful dissection [37], low number of pneumonectomies, accurate patient selection, and careful perioperative management [45].
\n
Treatment of postoperative complications after surgery for bronchiectasis depends on its type and severity. The treatment options for complications include: physiotherapy, tube thoracotomy, bronchoscopic treatment for atelectasis, negative suction applied to the chest tubes for prolonged air leak, surgical reintervention for closure of bronchopleural fistula, medical treatment or decortication for pleural empyema, pharmacological control of supraventricular arrhythmias, reexploration for postoperative bleeding, and mechanical ventilation for respiratory insufficiency [39, 41, 60].
\n
Cobanoglu et al. did not report any significant statistical difference between tubular and saccular morphologic types of bronchiectasis regarding postoperative complication rates; however, the most severe postoperative complication, bronchopleural fistula, developed in 2 (3.22%) cases with saccular bronchiectasis [50]. Zhou et al. did not find statistically significant difference in the rates of postoperative complications between thoracotomy and VATS procedure. Minor postoperative complications were reported after thoracotomy or completely VATS lobectomy, which included pneumonia, prolonged air leak (>7 days), and atelectasis [55]. Moreover, Hao et al. did not observe major postoperative complications such as bronchopleural fistula or respiratory insufficiency was observed in VATS and thoracotomy groups. The most common complication was persistent air leak for >7 days in 8.1% of VATS group and 6% of thoracotomy group [64].
\n
\n
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6.3 Symptomatic improvement
\n
The clinical results after surgical resection of bronchiectasis are frequently classified into three categories. The first category (asymptomatic; excellent response) includes patients who are completely free of any symptoms suggestive of bronchiectasis, and considered themselves cured. The second category (clinical improvement; good response) includes those considered improved who have had some relief of the symptoms but still had some chronic pulmonary complaints. The third category (no improvement; poor response) includes patients with no-change, no-reduction in preoperative symptoms, or who are worse off since surgical resection. [22, 31, 32, 35, 44, 46, 47, 50]. Some authors referred to the excellent response as well outcome [36] or perfect response [41].
\n
Sanderson et al. expanded the classification of the clinical symptomatic outcome to five categories as: excellent (no symptoms at all), good (full physical capacity, occasional cough and sputum), fair-improved (tendency to cough and sputum with susceptibility to respiratory infection, hemoptysis or dyspnea), poor (residual symptoms), and worse (steady deterioration) [23]. Other authors reduced the classification of the clinical condition in two categories only by dividing the patients into an improved group (“excellent” or “good” outcomes) and an unimproved group (“no change” or “worse” outcomes) [52].
\n
In literature, through a range of follow-up between 9 months and 14 years, the proportion of asymptomatic patients or excellent improvement after surgery ranged from 22.3% [22] to 89.5% [65], while the proportion of clinical improvement with reduction of preoperative symptoms ranged from 9.6% [64] to 80.7% [56], and no improvement, worseness or relapse was reported in 1.6% [58] to 42.3% [22].
\n
\n
\n
6.4 Quality of life (QOL)
\n
Patients with bronchiectasis report worse quality of life (QOL) than do persons in the general population [74, 75]. Recurrent bronchiectasis exacerbations are related to deterioration of lung function, progression of the disease, impairment of quality of life, and increased rate of mortality [76]. Postoperative QOL and the functional consequences of lung resection (pulmonary function and exercise capacity) are poorly addressed.
\n
Vallilo et al. reported a significant improvement of the QOL in patients with symptomatic bronchiectasis which was particularly relevant in the functional and physical QOL domains. Resection of the lung area which had not contributed to ventilatory response during exercise before surgery might enable the patients to maintain the exercise performance after lung resection without impairment to the response of the ventilatory system during maximal testing [60].
\n
\n
\n
6.5 Complete versus incomplete resection
\n
The proper surgical treatment should aim to complete resection of the bronchiectatic lesions. Thus, intraoperatively detected lesions should be resected as appropriate whether determined on preoperative imaging studies or not [32]. Complete resection is defined as an anatomic resection of all affected segments preoperatively identified by high-resolution computed tomography or bronchography [48, 54, 57]. However, some authors considered pulmonary resection complete if the patient was believed to be free of bronchiectasis after thoracotomy [31, 35].
\n
Completeness of surgical resection is affected by localization of the disease and pulmonary function (Figure 4). In patients with unilateral localized bronchiectasis, the most important prognostic factor for good surgical outcomes is complete resection of all diseased segments. In bilateral localized bronchiectasis, complete surgical resection should be attempted if lung function permits, including combinations of lobectomy with segmentectomy or wedge resections on the same siting or staged [24, 39, 73]; however, limited resection of the most predominant lesion is preferred for selected patients with bilateral diffuse bronchiectasis [34, 63]. The reported completeness of resection in patients with localized bronchiectasis ranged from 55.4% [23] to 94.2% [54].
\n
Figure 4.
Simplified algorithm for complete surgical resection according to extent of bronchiectasis.
\n
Sanderson et al. found a preponderance of excellent results after complete resection in comparison with incomplete resection (36% versus 10%, P < 0.005) [23]. Agasthian et al. found that complete resection resulted in a significant increase in proportion of asymptomatic patients than incomplete resection (65.2% versus 21.4%, p < 0.05) [28]. In the study by Kutlay et al., the excellent to good results of complete resection were significantly better than those of incomplete resection (98.5 versus 76.5%, P < 0.05) [32]. Similarly, other authors reported significantly better clinical results with complete resection than incomplete resection [35, 36, 44, 46, 50, 52].
\n
\n
\n
6.6 Predictors of postoperative outcomes
\n
There is no single independent perioperative variable that can predict occurrence of adverse events after lung resection with scant available data. In the study by Fujimoto et al., the logistic analyses extracted the type of bronchiectasis (cylindrical or others), the history of sinusitis, and the type of resection (complete or incomplete) for discrimination between patients with excellent or improved clinical outcome and patients with no clinical change [30]. Hiramatsu et al. reported immuno compromised status, Pseudomonas aeruginosa infection, and extent of residual bronchiectasis, as independent and significant factors of postoperative shorter relapse-free interval [53].
\n
Eren et al. fond that the lack of preoperative bronchoscopic examination, a FEV1 of <60% of the predicted value, a history of tuberculosis, and incomplete resection were independent predictors of postoperative complications [41]. Bagheri et al. statistically evaluated several variables including: sex, age, localization of disease, and complete or incomplete resection using multivariate logistic regression. Complete resection was found to have a significantly better surgical outcome compared to incomplete resection [46]. In the study by Zhang et al., the logistic regression analysis showed that tuberculous bronchiectasis, type of bronchiectasis (saccular versus others), and type of resection (incomplete or complete) were three independent factors associated with poor surgical outcome [48]. The multivariable analyses by Jin et al., showed that age, sputum volume, gram-negative bacillus infection, and bronchial stump coverage were the four independent factors related with poor surgical outcome [58].
\n
According to the reported results by Sahin et al., the prognostic variables in pediatric patients were: FEV1 less than 60% of the predicted value, hemoptysis, and duration of symptoms [59]. Interestingly, Gorur et al. stated that multi-segmental resectable bronchiectasis should not be considered an occult risk factor for morbidity after lung resection. Moreover, the number of resected segments, hemoptysis, and absence of preoperative fiberoptic bronchoscopy were not associated with postoperative complications. Impaired pulmonary function was significantly associated with residual air space; however it did not predict the risk of persistent air leak, atelectasis or empyema [51].
\n
Completion pneumonectomy is historically recognized as a high-risk procedure especially when done for a benign disease [77]. To reduce the high-risk of completion pneumonectomy when indicated, precautions such as optimal exposure, intrapericardial isolation of blood vessels, and bronchial reinforcement are recommended [78]. In the study by Agasthian et al., all died patients after lung resection had completion pneumonectomy. The causes of death were respiratory failure and intraoperative bleeding [28]. However, Fujimoto et al. reported acceptable mortality and morbidity after completion pneumonectomy without mortality and only one patient had postoperative bronchopleural fistula that could be managed conservatively [30].
\n
\n
\n
\n
7. Specific surgical considerations
\n
\n
7.1 Non-localized bronchiectasis
\n
Patients with non-localized (multi-segmental or bilateral) bronchiectasis are generally regarded as an exclusion of surgery [39]. However, considering the limited and palliative effect of medical treatment and the risk of transplantation or radical operation, recent studies offered a limited operation to some of these patients [34, 63]. Moreover, some surgeons favored surgery in non-localized bronchiectasis to prevent extension of the disease to the unaffected lung [38].
\n
George et al. suggested that bilateral bronchiectasis need not be a contraindication to operation. In properly selected patients, lasting symptomatic improvement can be provided by resection [24]. Mazieres et al. reported favorable outcome after a limited lung resection in properly selected symptomatic patients with severe multisegmental bilateral bronchiectasis, particularly those with cystic lesions and functionless territories [34].
\n
Schneiter et al. found the same patients’ satisfaction at 6 months after surgery for patients who had resectable non-localized or localized bronchiectasis, with non-significant differences in the rates of recurrent infection and hemoptysis [38]. Aghajanzadeh et al. reported the benefits of surgery in 87 bilateral non-localized bronchiectases, and concluded that staged bilateral resection for bronchiectases can be performed at any age with acceptable morbidity and mortality [39]. Additionally, Dai et al. reported the safety of lobectomy for the predominant lesions in non-localized bronchiectasis, with significant relief of symptoms, good rates of satisfaction, no operative mortality, and minimal postoperative complications [63].
\n
\n
\n
7.2 Surgery for bronchiectasis in children
\n
The prevalence of bronchiectasis in children ranges from 0.2 to 735 cases per 100,000 [79]. Cystic fibrosis is the most common cause of bronchiectasis in developed countries while in developing countries non-CF etiologies particularly post-infectious causes are more common [80]. Surgical treatment of bronchiectasis in children is considered for cases with resectable disease after failure of the proper medical treatment. Moreover, surgery can be considered in children with diffuse disease who have expected benefit after excision of the most predominant lesions [36, 79].
\n
In literature, the studies that evaluate surgical treatment of bronchiectasis in children are scanty. However, these studies confirmed the safety of surgery for childhood bronchiectasis with low rates of mortality and morbidity. Complete resection can be considered when possible, as most of the children can benefit from surgery especially if the total excision is accomplished [26, 35, 36, 43, 56, 59].
\n
The reported surgical outcomes in children with bronchiectasis highlight: acceptable mortality and morbidity [35, 36, 43, 56, 59], significant impact of surgery on improvement of symptoms and quality of life [43, 56], good results after segmentectomy when the pulmonary segment is entirely free of disease [26], increase the chance of cure after complete resection which results in significantly better outcome than incomplete resection [35, 43], preference of pneumonectomy instead of leaving residual disease when bronchiectasis is unilateral [36], and significant impact of duration of symptoms and timely intervention on the management and prognosis [59].
\n
\n
\n
\n
8. Conclusions
\n
Bronchiectasis is a significant chronic lung disease associated with vicious cycle of inflammation, infection, mucus accumulation, and structural tissue damage. Current guidelines recommend surgical treatment of bronchiectasis in patients with localized disease when symptoms are not controlled by optimized medical treatment. Other indications in literature include recurrent refractory or massive hemoptysis, bronchiectasis distal to tumors, and treatment of subsequent complications.
\n
HRCT is the gold standard imaging tool of bronchiectasis, as has a great help in preoperative localization of the lesions which affects the decision making for surgery. Preoperative bronchoscopy is important to diagnose the underlying causes of bronchial obstruction and to clear the airways by removal of secretions. Preoperative PFTs can be performed to determine the segments with little ventilatory contribution and minimal effects on postoperative pulmonary function after surgical resection. Perfusion scans can be used to determine the most affected non-perfused areas to be resected, particularly when the pulmonary function is affected. According to hemodynamic analysis of perfusion scans in diffuse bronchiectasis, surgery can be reserved for non-perfused cystic lesions which are more damaged than cylindrical lesions.
\n
Preoperative preparation for lung resection should include sputum culture analysis to modify antibiotic therapy with culture sensitivity results. It is crucial to eradicate active pulmonary infection and provide prophylactic antibiotic therapy with cephalosporin and aminoglycoside before surgery. Preoperative airway clearance techniques including active breathing, oscillating PEP, and postural drainage, are recommended to control infection and optimize the respiratory status. Other important preoperative considerations include nutritional support and pulmonary rehabilitation.
\n
Posterolateral thoracotomy is the standard approach for the surgical resection of bronchiectasis. The extent of resection depends on extent of the disease and cardiopulmonary reserve. Preservation of peribronchial tissues, short bronchial stump, and buttressing techniques are recommended to reduce postoperative air leak and BPF. The safety and feasibility of VATS in the treatment of bronchiectasis was shown in scant studies with low morbidity and mortality. The proper care after surgery should include bronchoscopic removal of secretions, pain control, chest physiotherapy, and appropriate antibiotic therapy.
\n
In literature, the mortality rates after lung resection range from 0.41% to 8.3%. The most common causes of early mortality are respiratory failure, intraoperative bleeding, postoperative pneumonia, empyema, pulmonary edema, and cardiac-related causes; while the most common causes of late mortality are respiratory failure, progressive respiratory disease, sepsis, coronary artery thrombosis, and cor pulmonale. The morbidity rates range from 7–38%. Atelctasis or sputum retention is the most common postoperative complication, followed by persistent air leak, pneumonia, and BPF. Most of the reported complications are minor, transient, and treatable. During follow-up periods between 9 months and 14 years, the proportion of asymptomatic patients (excellent improvement) after surgery ranges from 22.3% to 89.5%. Postoperative QOL is poorly addressed, but it can be improved after resection of functionless pulmonary segments.
\n
Complete resection of the affected parenchyma results in better clinical outcome than incomplete resection; however, completeness of resection is affected by localization of the disease and pulmonary function. A large number of predictors of surgical outcomes were investigated in literature, including: type of resection, type of bronchiectasis, immuno compromised status, Pseudomonas aeruginosa infection, extent of residual bronchiectasis, lack of preoperative bronchoscopic examination, FEV1 < 60% of the predicted value, tuberculosis, hemoptysis, duration of symptoms, age, sputum volume, gram-negative bacillus infection, bronchial stump coverage, and impaired pulmonary function.
\n
Recent studies reported acceptable outcomes after a limited lung resection for the most predominant lesion in properly selected patients with non-localized bronchiectasis. Surgery can be safely performed in children with bronchiectasis, particularly when the disease is resectable disease after failure of the proper medical treatment. Acceptable postoperative rates of mortality and morbidity and a significant symptomatic improvement were reported in children.
\n',keywords:"lung, bronchiectasis, productive cough, thoracic surgery, lung resection",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/72982.pdf",chapterXML:"https://mts.intechopen.com/source/xml/72982.xml",downloadPdfUrl:"/chapter/pdf-download/72982",previewPdfUrl:"/chapter/pdf-preview/72982",totalDownloads:271,totalViews:0,totalCrossrefCites:0,dateSubmitted:"January 23rd 2020",dateReviewed:"June 3rd 2020",datePrePublished:"August 14th 2020",datePublished:"December 2nd 2020",dateFinished:"August 14th 2020",readingETA:"0",abstract:"Bronchiectasis is a chronic clinicopathological disease of the lung characterized by chronic cough, sputum production, recurrent pulmonary infection, and persistent bronchial dilatation on computed tomography. For many years, bronchiectasis associated with high mortality and morbidity particularly before the advent of antibiotics. The medical treatment of bronchiectasis includes antibiotic therapy, airway clearance, bronchodilators, and anti-inflammatory agents. Surgery is mainly performed for localized disease after failure of the medical treatment, including: segmentectomy, lobectomy, and pneumonectomy. This chapter highlights the current surgical considerations for treatment of bronchiectasis, regarding indications of surgery, preoperative evaluation and preparation, available operative procedures, postoperative outcomes, and other important surgical issues.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/72982",risUrl:"/chapter/ris/72982",signatures:"Yasser Ali Kamal",book:{id:"7990",title:"Update in Respiratory Diseases",subtitle:null,fullTitle:"Update in Respiratory Diseases",slug:"update-in-respiratory-diseases",publishedDate:"December 2nd 2020",bookSignature:"Jose Carlos Herrera Garcia",coverURL:"https://cdn.intechopen.com/books/images_new/7990.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83880-895-2",printIsbn:"978-1-83880-894-5",pdfIsbn:"978-1-83880-896-9",editors:[{id:"224037",title:"Dr.",name:"Jose Carlos",middleName:null,surname:"Herrera Garcia",slug:"jose-carlos-herrera-garcia",fullName:"Jose Carlos Herrera Garcia"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Indications of surgery",level:"1"},{id:"sec_3",title:"3. Preoperative evaluation",level:"1"},{id:"sec_3_2",title:"3.1 Chest radiography",level:"2"},{id:"sec_4_2",title:"3.2 High resolution computed tomography (HRCT)",level:"2"},{id:"sec_5_2",title:"3.3 Bronchoscopy",level:"2"},{id:"sec_6_2",title:"3.4 Pulmonary function tests",level:"2"},{id:"sec_7_2",title:"3.5 Perfusion scans (ventilation/perfusion scintigraphy)",level:"2"},{id:"sec_9",title:"4. Preoperative preparation",level:"1"},{id:"sec_9_2",title:"4.1 Sputum culture analysis",level:"2"},{id:"sec_10_2",title:"4.2 Infection control",level:"2"},{id:"sec_11_2",title:"4.3 Chest physiotherapy and postural drainage",level:"2"},{id:"sec_12_2",title:"4.4 Other considerations",level:"2"},{id:"sec_14",title:"5. Surgical procedures",level:"1"},{id:"sec_14_2",title:"5.1 Thoracotomy",level:"2"},{id:"sec_15_2",title:"5.2 Video-assisted thoracoscopic surgery (VATS)",level:"2"},{id:"sec_16_2",title:"5.3 Postoperative care",level:"2"},{id:"sec_18",title:"6. Postoperative outcomes of lung resection",level:"1"},{id:"sec_18_2",title:"6.1 Mortality",level:"2"},{id:"sec_19_2",title:"6.2 Morbidity",level:"2"},{id:"sec_20_2",title:"6.3 Symptomatic improvement",level:"2"},{id:"sec_21_2",title:"6.4 Quality of life (QOL)",level:"2"},{id:"sec_22_2",title:"6.5 Complete versus incomplete resection",level:"2"},{id:"sec_23_2",title:"6.6 Predictors of postoperative outcomes",level:"2"},{id:"sec_25",title:"7. Specific surgical considerations",level:"1"},{id:"sec_25_2",title:"7.1 Non-localized bronchiectasis",level:"2"},{id:"sec_26_2",title:"7.2 Surgery for bronchiectasis in children",level:"2"},{id:"sec_28",title:"8. Conclusions",level:"1"},{id:"sec_31",title:"Abbreviations",level:"1"}],chapterReferences:[{id:"B1",body:'\nGoeminne C, De Soyza A. Bronchiectasis: How to be an orphan with many parents. The European Respiratory Journal. 2016;47:10-13\n'},{id:"B2",body:'\nAliberti S, Chalmers JD. Get together to increase awareness in bronchiectasis: A report of the 2nd world bronchiectasis conference. Multidisciplinary Respiratory Medicine. 2018;13(Suppl 1):28. DOI: 10.1186/s40248-018-0138-3\n'},{id:"B3",body:'\nContarini M, Shoemark A, Rademacher J, Finch S, Gramegna A, Gaffuri M, et al. Why, when and how to investigate primary ciliary dyskinesia in adult patients with bronchiectasis. Multidisciplinary Respiratory Medicine. 2018;13(Suppl 1):26\n'},{id:"B4",body:'\nQuint JK, Millett ER, Joshi M, Navaratnam V, Thomas SL, Hurst JR, et al. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: A population-based cohort study. The European Respiratory Journal. 2016;47(1):186-193\n'},{id:"B5",body:'\nSnell N, Gibson J, Jarrold I, Quint JK. Epidemiology of bronchiectasis in the UK: Findings from the British lung foundation’s ‘Respiratory health of the nation’ project. Respiratory Medicine. 2019;158:21-23\n'},{id:"B6",body:'\nHenkle E, Chan B, Curtis JR, Aksamit TR, Daley CL, Winthrop KL. Characteristics and health-care utilization history of patients with bronchiectasis in US Medicare enrollees with prescription drug plans, 2006 to 2014. Chest. 2018;154(6):1311-1320\n'},{id:"B7",body:'\nLin JL, Xu JF, Qu JM. Bronchiectasis in China. Annals of the American Thoracic Society. 2016;13:609-616\n'},{id:"B8",body:'\nDhar R, Singh S, Talwar D, Mohan M, Tripathi SK, Swarnakar R, et al. Bronchiectasis in India: Results from the European multicentre bronchiectasis audit and research collaboration (EMBARC) and respiratory research network of India registry. The Lancet Global Health. 2019;7(9):e1269-e1279\n'},{id:"B9",body:'\nMaselli DJ, Amalakuhan B, Keyt H, Diaz AA. Suspecting non-cystic fibrosis bronchiectasis: What the busy primary care clinician needs to know. International Journal of Clinical Practice. 2017;71(2):1-10. DOI: 10.1111/ijcp.12924\n'},{id:"B10",body:'\nSchäfer J, Griese M, Chandrasekaran R, Chotirmall SH, Hartl D. Pathogenesis, imaging and clinical characteristics of CF and non-CF bronchiectasis. BMC Pulmonary Medicine. 2018;18(1):79\n'},{id:"B11",body:'\nCole PJ. Inflammation: A two-edged sword – The model of bronchiectasis. European Journal of Respiratory Diseases. Supplement. 1986;147:6-15\n'},{id:"B12",body:'\nMoulton BC, Barker AF. Pathogenesis of bronchiectasis. Clinics in Chest Medicine. 2012;33:211-217\n'},{id:"B13",body:'\nSanthosham R. Bronchiectasis. In: Parikh Rajesh PB, editor. Tips and Tricks in Thoracic Surgery. London: Springer-Verlag; 2018. pp. 87-99\n'},{id:"B14",body:'\nChana ED, Wooten WI III, Hsiehh EWY, Johnstond KL, Shafferd M, et al. Diagnostic evaluation of bronchiectasis. Respiratory Medicine. 2019;X(1):100006. DOI: 10.1016/j.yrmex.2019.100006\n'},{id:"B15",body:'\nPolverino E, Goeminne PC, McDonnell MJ, Aliberti S, Marshall SE, Loebinger MR, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. The European Respiratory Journal. 2017;50:1700629\n'},{id:"B16",body:'\nSmith MP. Diagnosis and management of bronchiectasis. CMAJ. 2017;189:E828-E835. DOI: 10.1503/cmaj.160830\n'},{id:"B17",body:'\nPasteur MC, Bilton D, Hill AT. British thoracic society guideline for non-CF bronchiectasis. Thorax. 2010;65(Suppl 1):i1-i58\n'},{id:"B18",body:'\nLoebinger MR, Wells AU, Hansell DM, Chinyanganya N, Devaraj A, Meister M, et al. Mortality in bronchiectasis: A long-term study assessing the factors influencing survival. The European Respiratory Journal. 2009;34(4):843-849. DOI: 10.1183/09031936.00003709\n'},{id:"B19",body:'\nKoser U, Hill A. What’s new in the management of adult bronchiectasis? F1000Research. 2017;6(F1000 Facultyb Rev):527. DOI: 10.12688/f1000research.10613.1\n'},{id:"B20",body:'\nHill AT, Sullivan AL, Chalmers JD, De Soyza A, Elborn SJ, Floto AR, et al. British thoracic society guideline for bronchiectasis in adults. Thorax. 2019;74(Suppl 1):1-69. DOI: 10.1136/thoraxjnl-2018-212463\n'},{id:"B21",body:'\nHewlett TH, Ziperman HH. Bronchiectasis: Results of pulmonary resection. The Journal of Thoracic and Cardiovascular Surgery. 1960;40:71-78\n'},{id:"B22",body:'\nStreete BG, Salyer JM. Bronchiectasis: An analysis of 240 cases treated by pulmonary resection. The Journal of Thoracic and Cardiovascular Surgery. 1960;40:383-392\n'},{id:"B23",body:'\nSanderson JM, Kennedy MCS, Johnson MF, Manley DCE. Bronchiectasis: Results of surgical and conservative management - a review of 393 cases. Thorax. 1974;29:407\n'},{id:"B24",body:'\nGeorge SA, Leonardi HK, Overholt RH. Bilateral pulmonary resection for bronchiectasis: A 40-year experience. The Annals of Thoracic Surgery. 1979;28:48-53\n'},{id:"B25",body:'\nAnnest LS, Kratz JM, Crawford FA. Current results of treatment of bronchiectasis. The Journal of Thoracic and Cardiovascular Surgery. 1982;83:546-550\n'},{id:"B26",body:'\nWilson JF, Decker AM. The surgical management of childhood bronchiectasis: A review of 96 consecutive pulmonary resections in children with nontuberculous bronchiectasis. Annals of Surgery. 1982;195(3):354-363\n'},{id:"B27",body:'\nDogan R, Alp M, Kaya S, Ayrancioğlu K, Taştepe I, Unlü M, et al. Surgical treatment of bronchiectasis: A collective review of 487 cases. The Thoracic and Cardiovascular Surgeon. 1989;37(3):183-186\n'},{id:"B28",body:'\nAgasthian T, Deschamps C, Trastek VF, Allen MS, Pairolero PC. Surgical management of bronchiectasis. The Annals of Thoracic Surgery. 1996;62:976-980\n'},{id:"B29",body:'\nAshour M, Al-Kattan K, Rafay MA, Saja KF, Hajjar W, Al-Fraye AR. Current surgical therapy for bronchiectasis. World Journal of Surgery. 1999;23(11):1096-1104\n'},{id:"B30",body:'\nFujimoto T, Hillejan L, Stamatis G. Current strategy for surgical management of bronchiectasis. The Annals of Thoracic Surgery. 2001;72:1711-1715\n'},{id:"B31",body:'\nPrieto D, Bernardo J, Matos MJ, Euge Ânio L, Antunes M. Surgery for bronchiectasis. European Journal of Cardio-Thoracic Surgery. 2001;20:19-23\n'},{id:"B32",body:'\nKutlay H, Cangir AK, Enön S, Sahin E, Akal M, Güngör A, et al. Surgical treatment in bronchiectasis: Analysis of 166 patients. European Journal of Cardio-Thoracic Surgery. 2002;21:634-637\n'},{id:"B33",body:'\nBalkanli K, Genc O, Dakak M, Gürkök S, Gözübüyük A, Caylak H, et al. Surgical management of bronchiectasis: Analysis and short-term results in 238 patients. European Journal of Cardio-Thoracic Surgery. 2003;24:699-702\n'},{id:"B34",body:'\nMazieres J, Murris M, Didier A, Giron J, Dahan M, Berjaud J, et al. Limited operation for severe multisegmental bilateral bronchiectasis. The Annals of Thoracic Surgery. 2003;75:382-387\n'},{id:"B35",body:'\nHaciibrahimoglu G, Fazlioglu M, Olcmen A, Gurses A, Bedirhan MA. Surgical management of childhood bronchiectasis due to infectious disease. The Journal of Thoracic and Cardiovascular Surgery. 2004;127:1361-1365\n'},{id:"B36",body:'\nOtgun I, Karnak I, Tanyel FC, Senocak ME, Buyukpamukcu N. Surgical treatment of bronchiectasis in children. Journal of Pediatric Surgery. 2004;39:1532-1536\n'},{id:"B37",body:'\nAl-Kattan KM, Essa MA, Hajjar WM, Ashour MH, Saleh WN, Rafay MA. Surgical results for bronchiectasis based on hemodynamic (functional and morphologic) classification. The Journal of Thoracic and Cardiovascular Surgery. 2005;130:1385-1390\n'},{id:"B38",body:'\nSchneiter D, Meyer N, Lardinois D, Korom S, Kestenholz P, Weder W. Surgery for non-localized bronchiectasis. The British Journal of Surgery. 2005;92(7):836-839\n'},{id:"B39",body:'\nAghajanzadeh M, Sarshad A, Amani H, Alavy A. Surgical management of bilateral bronchiectases: Results in 29 patients. Asian Cardiovascular & Thoracic Annals. 2006;14:219-222\n'},{id:"B40",body:'\nYuncu G, Ceylan KC, Sevinc S, Ucvet A, Kaya SO, Kiter G, et al. Functional results of surgical treatment of bronchiectasis in a developing country. Archivos de Bronconeumología. 2006;42:183-188\n'},{id:"B41",body:'\nEren S, Esme H, Avci A. Risk factors affecting outcome and morbidity in the surgical management of bronchiectasis. The Journal of Thoracic and Cardiovascular Surgery. 2007;134:392-398\n'},{id:"B42",body:'\nGuerra MS, Miranda JA, Leal F, Vouga L. Surgical treatment of bronchiectasis. Revista Portuguesa de Pneumologia. 2007;13(5):691-701\n'},{id:"B43",body:'\nSirmali M, Karasu S, Turut H, Gezer S, Kaya S, Taştepe I, et al. Surgical management of bronchiectasis in childhood. European Journal of Cardio-Thoracic Surgery. 2007;31:120-123\n'},{id:"B44",body:'\nStephen T, Thankachen R, Madhu AP, Neelakantan N, Shukla V, Korula RJ. Surgical results in bronchiectasis: Analysis of 149 patients. Asian Cardiovascular & Thoracic Annals. 2007;15:290-296\n'},{id:"B45",body:'\nGiovannetti R, Alifano M, Stefani A, Legras A, Grigoroiu M, Collet JY, et al. Surgical treatment of bronchiectasis: Early and long-term results. Interactive CardioVascular and Thoracic Surgery. 2008;7:609-612\n'},{id:"B46",body:'\nBagheri R, Haghi SZ, Fattahi Masoum SH, Bahadorzadeh L. Surgical management of bronchiectasis: Analysis of 277 patients. The Thoracic and Cardiovascular Surgeon. 2010;58:291-294\n'},{id:"B47",body:'\nGursoy S, Ozturk AA, Ucvet A, Erbaycu AE. Surgical management of bronchiectasis: The indications and outcomes. Surgery Today. 2010;40:26-30\n'},{id:"B48",body:'\nZhang P, Jiang G, Ding J, Zhou X, Gao W. Surgical treatment of bronchiectasis: A retrospective analysis of 790 patients. The Annals of Thoracic Surgery. 2010;90:246-250\n'},{id:"B49",body:'\nCaylak H, Genc O, Kavakli K, Gurkok S, Gozubuyuk A, Yucel O, et al. Surgical management of bronchiectasis: A collective review of 339 patients with long-term follow-up. The Thoracic and Cardiovascular Surgeon. 2011;59:479-483\n'},{id:"B50",body:'\nCobanoglu U, Yalcinkaya I, Er M, Isik AF, Sayir F, Mergan D. Surgery for bronchiectasis: The effect of morphological types to prognosis. Annals of Thoracic Medicine. 2011;6(1):25-32\n'},{id:"B51",body:'\nGorur R, Turut H, Yiyit N, Candas F, Yildizhan A, Sen H, et al. The influence of specific factors on postoperative morbidity in young adults with bronchiectasis. Heart, Lung & Circulation. 2011;20:468-472\n'},{id:"B52",body:'\nSehitogullari A, Bilici S, Sayir F, Cobanoglu U, Kahraman A. A long-term study assessing the factors influencing survival and morbidity in the surgical management of bronchiectasis. Journal of Cardiothoracic Surgery. 2011;6:161\n'},{id:"B53",body:'\nHiramatsu M, Shiraishi Y, Nakajima Y, Miyaoka E, Katsuragi N, Kita H, et al. Risk factors that affect the surgical outcome in the management of focal bronchiectasis in a developed country. The Annals of Thoracic Surgery. 2012;93:245-250\n'},{id:"B54",body:'\nAl-Refaie RE, Amer S, El-Shabrawy M. Surgical treatment of bronchiectasis: A retrospective observational study of 138 patients. Journal of Thoracic Disease. 2013;5:228-233\n'},{id:"B55",body:'\nZhou ZL, Zhao H, Li Y, Li JF, Jiang GC, Wang J. Completely thoracoscopic lobectomy for the surgical management of bronchiectasis. Chinese Medical Journal. 2013;126:875-878\n'},{id:"B56",body:'\nAndrade CF, Melo IA, Holand AR, Silva ÉF, Fischer GB, Felicetii JC. Surgical treatment of non-cystic fibrosis bronchiectasis in Brazilian children. Pediatric Surgery International. 2014;30:63-69\n'},{id:"B57",body:'\nBalci AE, Balci TA, Ozyurtan MO. Current surgical therapy for bronchiectasis: Surgical results and predictive factors in 86 patients. The Annals of Thoracic Surgery. 2014;97:211-217\n'},{id:"B58",body:'\nJin YX, Zhang Y, Duan L, Yang Y, Jiang GN, Ding JA. Surgical treatment of bronchiectasis – A retrospective observational study of 260 patients. International Journal of Surgery. 2014;12:1050-1054\n'},{id:"B59",body:'\nSahin A, Meteroglu F, Kelekci S, Karabel M, Eren C, Eren S, et al. Surgical outcome of bronchiectasis in children: Long term results of 60 cases. Klinische Pädiatrie. 2014;226:233-237\n'},{id:"B60",body:'\nVallilo CC, Terra RM, de Albuquerque AL, Suesada MM, Mariani AW, Salge JM, et al. Lung resection improves the quality of life of patients with symptomatic bronchiectasis. The Annals of Thoracic Surgery. 2014;98:1034-1041\n'},{id:"B61",body:'\nCoutinho D, Fernandes P, Guerra M, Miranda J, Vouga L. Surgical treatment of bronchiectasis: A review of 20 years of experience. Revista Portuguesa de Pneumologia. 2016;22(2):82-85\n'},{id:"B62",body:'\nBaysungur V, Dogruyol T, Ocakcioglu I, Misirlioglu A, Evman S, Kanbur S, et al. The feasibility of thoracoscopic resection in bronchiectasis. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2017;27(3):194-196\n'},{id:"B63",body:'\nDai J, Zhu X, Bian D, Fei K, Jiang G, Zhang P. Surgery for predominant lesion in nonlocalized bronchiectasis. The Thoracic and Cardiovascular Surgeon. 2017;153:979-985\n'},{id:"B64",body:'\nHao X, Dazhong L, Lei Y, Jiaying Z, Linyou Z. Surgical treatment of bronchiectasis: 5 years of experience at a single institution. Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2019;29(6):826-830\n'},{id:"B65",body:'\nNega B, Ademe Y, Tizazu A. Bronchiectasis: Experience of surgical management at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia. Journal of Health Sciences. 2019;29(4):471-476. DOI: 10.4314/ejhs.v29i4.8\n'},{id:"B66",body:'\nOcakcioglu I. Uniportal thoracoscopic treatment in bronchiectasis patients: Preliminary experience. Videosurgery and Other Miniinvasive Techniques. 2019;14(2):304-310\n'},{id:"B67",body:'\nCantin L, Bankier AA, Eisenberg RL. Bronchiectasis. AJR. American Journal of Roentgenology. 2009;193(3):W158-W171\n'},{id:"B68",body:'\nvan der Bruggen-Bogaarts BA, van der Bruggen HM, van Waes PF, Lammers JW. Screening for bronchiectasis. A comparative study between chest radiography and high-resolution CT. Chest. 1996;109(3):608-611\n'},{id:"B69",body:'\nYoung K, Aspestrand F, Kolbenstvedt A. High resolution CT and bronchography in the assessment of bronchiectasis. Acta Radiologica. 1991;32:439-441\n'},{id:"B70",body:'\nFirth J. Respiratory medicine: Bronchiectasis. Clinical Medicine. 2019;19(1):64-67\n'},{id:"B71",body:'\nAshour M. Hemodynamic alterations in bronchiectasis: A basis for a new subclassification of the disease. The Journal of Thoracic and Cardiovascular Surgery. 1996;112:328-334\n'},{id:"B72",body:'\nDusica S, Nebojsa L, Miodrag M, Angelina B, Sveljko S, Radmilo J. Preoperative preparation of patients with infectious and restrictive respiratory diseases as comorbidities. Acta Chirurgica Iugoslavica. 2011;58(2):63-69\n'},{id:"B73",body:'\nAgasthian T. Surgery for bronchiectasis. Journal of Visceral Surgery. 2018;4:235\n'},{id:"B74",body:'\nO’Leary CJ, Wilson CB, Hansell DM, Cole PJ, Wilson R, Jones PW. Relationship between psychological well-being and lung health status in patients with bronchiectasis. Respiratory Medicine. 2002;96:686-692\n'},{id:"B75",body:'\nOlveira G, Olveira C, Gaspar I, Dorado A, Cruz I, Soriguer F, et al. Depression and anxiety symptoms in bronchiectasis: Associations with health-related quality of life. Quality of Life Research. 2013;22:597-665\n'},{id:"B76",body:'\nArtaraz A, Crichton ML, Finch S, Abo-Leyah H, Goeminne P, Aliberti S, et al. Development and initial validation of the bronchiectasis exacerbation and symptom tool (BEST). Respiratory Research. 2020;21(1):18\n'},{id:"B77",body:'\nMcGovern EM, Trastek VF, Pairolero PC, Payne WS. Completion pneumonectomy: Indications, complications and results. The Annals of Thoracic Surgery. 1988;46:141-146\n'},{id:"B78",body:'\nGregoire J, Deslauriers J, Guojin L, Rouleau J. Indications, risks, and results of completion pneumonectomy. The Journal of Thoracic and Cardiovascular Surgery. 1993;105:918-924\n'},{id:"B79",body:'\nMcCallum GB, Binks MJ. The epidemiology of chronic suppurative lung disease and bronchiectasis in children and adolescents. Frontiers in Pediatrics. 2017;5:27\n'},{id:"B80",body:'\nKumar A, Lodha R, Kumar P, Kabra SK. Non-cystic fibrosis bronchiectasis in children: Clinical profile, etiology and outcome. Indian Pediatrics. 2015;52(1):35-37\n'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Yasser Ali Kamal",address:"yaser_ali_kamal@yahoo.com",affiliation:'
Department of Cardiothoracic Surgery, Faculty of Medicine, Minia University, El-Minya, Egypt
'}],corrections:null},book:{id:"7990",title:"Update in Respiratory Diseases",subtitle:null,fullTitle:"Update in Respiratory Diseases",slug:"update-in-respiratory-diseases",publishedDate:"December 2nd 2020",bookSignature:"Jose Carlos Herrera Garcia",coverURL:"https://cdn.intechopen.com/books/images_new/7990.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83880-895-2",printIsbn:"978-1-83880-894-5",pdfIsbn:"978-1-83880-896-9",editors:[{id:"224037",title:"Dr.",name:"Jose Carlos",middleName:null,surname:"Herrera Garcia",slug:"jose-carlos-herrera-garcia",fullName:"Jose Carlos Herrera Garcia"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},profile:{item:{id:"171493",title:"Dr.",name:"Angeles",middleName:null,surname:"Dominguez",email:"admguez@uvigo.es",fullName:"Angeles Dominguez",slug:"angeles-dominguez",position:null,biography:null,institutionString:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",totalCites:0,totalChapterViews:"0",outsideEditionCount:0,totalAuthoredChapters:"2",totalEditedBooks:"0",personalWebsiteURL:null,twitterURL:null,linkedinURL:null,institution:{name:"University of Vigo",institutionURL:null,country:{name:"Spain"}}},booksEdited:[],chaptersAuthored:[{title:"Thermal Behaviour of Pure Ionic Liquids",slug:"thermal-behaviour-of-pure-ionic-liquids",abstract:null,signatures:"Elena Gómez, Noelia Calvar and Ángeles Domínguez",authors:[{id:"171493",title:"Dr.",name:"Angeles",surname:"Dominguez",fullName:"Angeles Dominguez",slug:"angeles-dominguez",email:"admguez@uvigo.es"},{id:"172443",title:"Dr.",name:"Noelia",surname:"Calvar",fullName:"Noelia Calvar",slug:"noelia-calvar",email:"ncalvar@fe.up.pt"},{id:"172444",title:"Dr.",name:"Elena",surname:"Gómez",fullName:"Elena Gómez",slug:"elena-gomez",email:"elenagc@uvigo.es"}],book:{title:"Ionic Liquids",slug:"ionic-liquids-current-state-of-the-art",productType:{id:"1",title:"Edited Volume"}}},{title:"Extraction of Aromatic Compounds from Their Mixtures with Alkanes: From Ternary to Quaternary (or Higher) Systems",slug:"extraction-of-aromatic-compounds-from-their-mixtures-with-alkanes-from-ternary-to-quaternary-or-high",abstract:"Ionic liquids have been proposed as separation agents for liquid extraction of aromatic compounds from their mixtures with alkanes, with the aim of improving the separation process and replacing conventional organic solvents. A significant number of experimental liquid-liquid equilibrium data for ternary system alkane + aromatic compound + ionic liquid can be found in literature; however there are few data for quaternary or higher systems involving more than one aliphatic compound, several aromatic compounds or a mixture of ionic liquids as separation agent. These data are also necessary because molecular interactions between the compounds in the mixture can modify the affinity of the solvent for the aromatic compound of interest. In this chapter we review the published data involving more than three components, and we present new liquid-liquid equilibrium data for the quaternary systems heptane + cyclohexane + toluene +1-ethyl-3-methylimidazolium bis{(trifluoromethyl)sulfonyl}imide and heptane + cyclohexane + toluene + 1-hexyl-3-methylimidazolium bis{(trifluoromethyl)sulfonyl}imide.",signatures:"Ángeles Domínguez, Begoña González, Patricia F. Requejo and Sandra Corderí",authors:[{id:"171493",title:"Dr.",name:"Angeles",surname:"Dominguez",fullName:"Angeles Dominguez",slug:"angeles-dominguez",email:"admguez@uvigo.es"},{id:"294467",title:"Dr.",name:"Begoña",surname:"Gonzalez",fullName:"Begoña Gonzalez",slug:"begona-gonzalez",email:"bgp@uvigo.es"},{id:"300565",title:"Dr.",name:"Patricia F.",surname:"Requejo",fullName:"Patricia F. Requejo",slug:"patricia-f.-requejo",email:"pfernanreq@uvigo.es"},{id:"300566",title:"Dr.",name:"Sandra",surname:"Corderí",fullName:"Sandra Corderí",slug:"sandra-corderi",email:"scorderi@uvigo.es"}],book:{title:"Solvents, Ionic Liquids and Solvent Effects",slug:"solvents-ionic-liquids-and-solvent-effects",productType:{id:"1",title:"Edited Volume"}}}],collaborators:[{id:"18064",title:"Dr.",name:"Rafael",surname:"Martínez Palou",slug:"rafael-martinez-palou",fullName:"Rafael Martínez Palou",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:"I was born in Cuba in october 30, 1964. I studied Chemistry in Havana University (1982-1987). After working 8 years ago in a research centre of the sugar industry I moved to Mexico to studied MS (1995-1997) and PhD (1997-2002) in Organic Chemistry. I work as research in Mexican Petroleum Institute since 2002. I do research in applied organic chemistry.",institutionString:null,institution:null},{id:"18306",title:"Dr.",name:"Farzaneh",surname:"Shemirani",slug:"farzaneh-shemirani",fullName:"Farzaneh Shemirani",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"19012",title:"Dr.",name:"Chuan-Fu",surname:"Liu",slug:"chuan-fu-liu",fullName:"Chuan-Fu Liu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"South China University of Technology",institutionURL:null,country:{name:"China"}}},{id:"51333",title:"Prof.",name:"Samir",surname:"Abu-Eishah",slug:"samir-abu-eishah",fullName:"Samir Abu-Eishah",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/51333/images/2527_n.jpg",biography:"I have over 32 years of experience at four different universities (Jordan University of Science & Technology, University of Jordan, University of Bahrain and currently, UAE University). I have taught Process Modeling & Simulation, Process and Plant Design and Process Optimization. In addition I taught other core and specialized courses in chemical engineering, for example, Operations Research, Process Control, Advanced Process Control, and Petroleum Refining Engineering. I have developed laptop teaching material for Process Modeling & Simulation, Process and Plant Design and Petroleum Refining Engineering. \nI have supervised many graduation projects on gas processing (e.g., Aromatic Emission Minimization, Design and Application of Hydrocarbons’ Vapor Recovery Unit, Design of a Sour Natural Gas Processing Facility in Abu Dhabi). I have supervised term projects on energy integration through the Process & Plant Design course. My PhD thesis was on: Design and Control of a Two-Column Distillation Process for the Separation of Homogeneous Binary Azeotropic Mixtures. The first publication on that subject appeared in 1985. My PhD thesis is a mix of process modeling, simulation, energy integration, process optimization, process design, and process control. I have also published, among others, several papers on vapor-liquid and liquid-liquid equilibria and prediction of critical properties of binary fluid mixtures with emphasis on hydrocarbon/gas mixtures.\nI have supervised 9 M.Sc. theses (7 in Jordan and 4 in UAE) in addition to other graduate and term projects and I was a member of the examining committee of many M.Sc. theses (CHE, ME, Chemistry, Environmental Science Master Program, and Water Resources Master Program) and an examiner in the qualifying exam for PhD students.\nI also supervised, among other works, a thesis on “Investigation on the Minimization of SO2 Emissions at Abu Dhabi Gas Liquefaction Company Limited (ADGAS) and Its Impact on Ambient Air Quality” and published two papers on that subject. \nIn addition, I have supervised many graduation projects during my career (and examiner of many others) that include process modeling, simulation, design and control as applied to oil and natural gas processing.\nI am the reviewer for many international scientific journals and associate editor of the Emirates Journal for Scientific Research (UAE University). I have over 300 citations for my published research in peer-reviewed journals.\nI have concentrated in my research on process modeling and simulation of chemical processes. I have organized and offered short courses on process modeling and simulation, process safety, risk assessment and analysis, and several others that are related to hydrocarbons processing and handling. I have been serving the community in many aspects at the various locations during my career. I have been a member of national committees (Standards and Codes, Non-CFC Standards, Jury Expert for Industrial Claims). I also supervised training at different industrial and professional entities. I have built a very good record with industry and received grants from different industries in Jordan (Jordan Phosphate Mines Co. and Arab Potash Co.) In the UAE I have received grants from (UAE University, General Holding Corporation for work on steel slag in cement manufacturing, Doosan Heavy Industries on desalination plants, Ministry of Presidential Affairs on Horizon for Petrochemicals in UAE, and recently from Emirates Foundation on photocatalytic conversion of CO2 back to hydrocarbons using TiO2 nanocatalyst and UV and/or visible light). I also received international grants from Japan Petroleum Institute and from Overseas Development Administration in Britain).\nI have been very competitive in getting research funding at the interdisciplinary and national levels and I am willing to engage myself in collaborative research, outstanding scholarly activities that will lead to national, regional and international recognition. In this regards, I have published 2 chapters in two books by Intech Open Access on “Ionic Liquids: Recycling for Reuse” in 2011 and \\Utilization of Ionic Liquids in Wood and Wood-Related Applications — A Review\\ in 2015",institutionString:null,institution:{name:"United Arab Emirates University",institutionURL:null,country:{name:"United Arab Emirates"}}},{id:"139343",title:"Dr.",name:"Magdalena",surname:"Maciejewska",slug:"magdalena-maciejewska",fullName:"Magdalena Maciejewska",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/139343/images/system/139343.jpeg",biography:"Magdalena Maciejewska received her M.Sc. (Polymer Technology) from Lodz University of Technology, Lodz, Poland, in 2004. She obtained her Ph.D. in the field of technical sciences (Chemical Technology) and Ph.D. D.Sc. from the same university, in 2008 and 2018, respectively. She is currently working as Assistant Professor at Lodz University of Technology, in the Institute of Polymer and Dye Technology, Lodz, Poland. Her research work has been credited with 8 national patents, 40 research and review articles in peer-reviewed national and international journals, 10 book chapters in international and national books and 31 proceedings. She has attended more than 30 international and domestic conferences. She has supervised 50 diploma thesis and was an assistant supervisor of 3 Ph.D. theses. 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General requirements for Open Access to Horizon 2020 research project outputs are found within Guidelines on Open Access to Scientific Publication and Research Data in Horizon 2020. The guidelines, in their simplest form, state that if you are a Horizon 2020 recipient, you must ensure open access to your scientific publications by enabling them to be downloaded, printed and read online. Additionally, said publications must be peer reviewed.
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Publishing with IntechOpen means that your scientific publications already meet these basic requirements. It also means that through our utilization of open licensing, our publications are also able to be copied, shared, searched, linked, crawled, and mined for text and data, optimizing our authors' compliance as suggested by the European Commission.
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When choosing a publication, Horizon 2020 grant recipients are encouraged to provide open access to various types of scientific publications including monographs, edited books and conference proceedings.
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IntechOpen publishes all of the aforementioned formats in compliance with the requirements and criteria established by the European Commission for the Horizon 2020 Program.
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Authors requiring additional information are welcome to send their inquiries to funders@intechopen.com
Publishing with IntechOpen means that your scientific publications already meet these basic requirements. It also means that through our utilization of open licensing, our publications are also able to be copied, shared, searched, linked, crawled, and mined for text and data, optimizing our authors' compliance as suggested by the European Commission.
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Metadata for all publications is also automatically deposited in IntechOpen's OAI repository, making them available through the Open Access Infrastructure for Research in Europe's (OpenAIRE) search interface further establishing our compliance.
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In other words, publishing with IntechOpen guarantees compliance.
When choosing a publication, Horizon 2020 grant recipients are encouraged to provide open access to various types of scientific publications including monographs, edited books and conference proceedings.
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IntechOpen publishes all of the aforementioned formats in compliance with the requirements and criteria established by the European Commission for the Horizon 2020 Program.
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Authors requiring additional information are welcome to send their inquiries to funders@intechopen.com
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