Segmental resection in tuberculosis.

The total extirpation of the offending lesion and the preservation of as much normal lung tissue as possible are the major objectives in excislonal treatment of pulmonary disease. The increased use of limited resection represents the surgical approach to obtain these desirable objectives. For more than a decade, segmental resection has been accepted as a rational procedure especially in the treatment of bronchiectasis, a disease process which usually has a typical segmental distribution. The acceptance of segmental resection as a rational approach in the surgical treatment of tuberculosis was delayed by the concept that tuberculosis is a disseminated disease, never well confined to segmental boundaries. However, in recent years the exploration of early tuberculous lesions has demonstrated that the major necrotic lesion is frequently confined to one or two segments. In addition, the antimicrobial drugs have come upon the scene and made all surgical procedures much safer in the tuberculous patient. They frequently result in such complete resolution of the disease process that the residual necrotic focus is well contained In a segment, subsegment, or even a smaller unit of the lung. These facts plus the surgeons improved knowledge of the segmental anatomy and increased experience with this surgical procedure has led to rapid expansion In the use of segmental resection In the treatment of tuberculosis. Numerous reports have appeared during the past few years on the use of this procedure. By and large, the reported results are excellent. However, it is timely to emphasize that such results are secured only when segmental resection Is used In a carefully selected gr,oup of patients. These are usually in excellent general condition, are in good immunological balance with their disease, and have limited lesions. The surgery is applied at the ideal time under the protection of the antimicrobial drugs in a well coordinated therapeutic program. When segmental resection is used in patients representing failures to other collapse therapy or surgical procedures, or in the presence of extensive disease as a salvage procedure, results are not so happy; in fact, they are poor. The purpose of this paper is to contrast results In these two groups of patients and to define the place of segmental resection in the surgical treatment of tuberculosis. This study consists of an analysis of 123 segmental resections performed in the streptomycin era between January, 1947 and January, 1952. During this period, a total of 539 resections were performed In the treatment of