Pulmonary resection for massive hemoptysis: Over 20 years of experience;

Massive hemoptysis, often exceeding 400ml, is a critical emergency with uncertain definitions. We aim to analyze the epidemiology, indications, and outcomes of massive hemoptysis surgery. This retrospective and descriptive study included all patients surgically treated for massive hemoptysis from 2002 to 2022 in Abderahman Mami University Hospital, Tunisia. Data of 37 patients, mean age of 47, female/male 5/32, 62.2% smokers, 10.8% had COPD. A history of tuberculosis (TBC) was noted in 35.1% of patients. All patients had an initial CXR to localize the bleeding site. Bronchoscopy revealed active bleeding in 37.8% and endobronchial blood clot in 10.8%, mainly in the right superior lobe (35.1%) and left superior lobe (24.3%). Initial medical stabilization failed in all patients with 21.6% requiring transfusions for hemodynamic instability. Embolization was performed and unsuccessful in 16.2%. Surgical interventions included 83.8% lobectomies, 2.7% pneumonectomy, and 13.5% segmentectomies, all performed via postero-lateral thoracotomy. Complications occurred in 37.8% of cases: surgical reintervention (13.5%), atelectasis (10.8%), prolonged air leaks (13.5%), pneumothorax (8.1%), septic complications (8.1%), cerebrovascular accidents (5.4%), and mortality (8.1%). Pathologies concluded : bronchiectasis (35.1%), tuberculosis (21.6%), aspergillosis (10.8%), abscesses (10.8%), pulmonary hydatid cysts (10.8%), arteriovenous malformations, and aneurysms (10.8%), and neoplasms (2.7%). Massive hemoptysis imposes urgent investigations and treatment. Surgical intervention becomes crucial when initial stabilization fails as it can effectively control bleeding and enhance survival.