Title:  Major lung resection in the management of tuberculosis: indications and outcomes of pneumonectomy

introduction: Major lung resections remain an important component of the treatment for certain forms of tuberculosis despite well conducted medical treatment.

Objective: The aim of this study is to analyse the indication and outcomes of pneumonectomy in the management of sequelae and active forms of this infection.

Method: Between 2000 et 2022, 25 patients underwent pneumonectomy for tuberculosis infection at the thoracic surgery department of Abderrahman Mami Hospital in Ariana,Tunisia.

Results: there were 17 men and 8 women with an average age of 48 years. chronic bronchorrhea and hemoptysis were the main functional signs. Surgical indication was a destroyed lung isolated in 10 cases, complicated by an aspergilloma complex in 7 cases , bronchial dilatation lesions in 5 cases, tuberculous pyopneumothorax in 1 patient, ans multidrug-resistant tuberculosis in 2. The involvement was the right side in 14 cases. The surgical procedure was pneumonectomyin 23 cases and pleuropneumonectomy in 2 cases. Postoperative recovery was unevenful in 72% of cases. Four patients died, and 3 had pyothorax on pneumonectomy cavity, 2 of whom had bronchopleural fistula. Late outcomes were satisfactory after and average follow-up of 3 years.

Conclusion:adequate preoperative preparation and identification of high-risk patients are key to reducing postoperative morbidity and mortality rates.