PURPOSE: Interstitial lung disease (ILD) commonly complicates the course of patients with connective tissue disease (CTD).We present an evaluation of the usefulness of pulmonary wedge resection biopsy in this group of patients.
METHODS: Retrospective review of a ten year institutional experience in open and thoracoscopic lung biopsy performed in patients with CTD associated ILD. Demographics, clinical variables and inhospital evolution and outcomes were documented for open and thoracoscopic biopsy. Early biopsy (first 14 days of hospitalization) was compared to biopsies done later in the hospital stay.
RESULTS: 58 patients were identified with a mean age of 40±15 years. Female patients were more commonly affected (65.5%) than male. Most common diagnoses were Systemic Lupus Erythematosus, Wegener's granulomatosis and Sjögren's syndrome. The majority of patients were receiving steroid treatment (74%) and half of them required mechanical ventilation. Early biopsy was done in (54%) of the cases. 62% of the biopsies were open, while the remaining was thoracoscopic, with a mean operative time of 79 and 75 minutes respectively. There were 11 complications (30%) in the open surgery group; being alveolopleural fistula, bleeding and pneumothorax the most common. There was no statistical difference in the complication rates between the open and thoracoscopic group (p=0.291). The therapeutic index (change of diagnosis, initiation, modification or withdrawal of treatment) was 0.82. Post-operative stay was significantly lower in the minimally invasive group (p=0.003). Total hospital stay was significantly lower in the early biopsy group (p=0.009). A higher mortality risk was found for patients under mechanical ventilation (p=0.003). No statistical difference in mortality rates was found for the early biopsy when compared to late biopsy; nor for the thoracoscopic versus open surgery groups.
CONCLUSIONS: The thoracoscopic approach lowered postoperative stay. Early biopsy reduced total hospital stay. Therefore, a minimally invasive pulmonary biopsy should be recommended for selected patients with CTD associated ILD.
CLINICAL IMPLICATIONS: Both open and thoracoscopic pulmonary wedge resection appear to be safe and have an acceptable therapeutic impact index.
DISCLOSURE: The following authors have nothing to disclose: Juan Carlos Jacinto-Tinajero, Luis Martin-Del-Campo, Rocío Carrera-Cerón, Susana Nápoles-Medina, Guerrero-Salas David, Alethse De-la-Torre, Luis Marcelo Argote-Greene, Patricio Santillán-Doherty
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