A patient with tuberculosis and lung cancer recovered and remains healthy and active for more than 10 years after the operation.

Tuberculosis remains a major infectious disease, with an estimated 10 million new cases globally in 2018, according to the World Health Organisation. The treatment of this condition usually involves a long-term intake of medications — for at least 6 months. When the patient is also affected by other lung diseases such as cancer it is much harder to choose the best therapeutic strategy. Sechenov University medics performed surgery and follow-up treatment of a patient who presented both tuberculosis and lung cancer; he successfully underwent the procedures and remains healthy for more than 10 years after that. The case has been reported in BMC Pulmonary Medicine.

The 53-year-old male was diagnosed in 2007 with cavitary tuberculosis of the right upper lung lobe, as well as highly differentiated squamous cell carcinoma in the right main bronchus. Half a year of anti-tubercular treatment did not give any effect. At the same time, the tumour was ruled out inoperable and chemo- or radiotherapy was also not advised because of tuberculosis. The patient was referred to the clinic in 2008 with worsening symptoms: weakness, cough, and fever. The doctors decided to operate on him and carried out the circular resection of the tracheal bifurcation together with the right pneumonectomy (lung removal). This type of surgery is very rare and almost never performed in Russia.

After the surgery, the patient was discharged in good condition and continued to receive his anti-tubercular therapy for a year. However, 4 months post-operation he was re-admitted with stenosis — narrowing of the airways. The issue was again resolved with surgery.

For more than 5 years after the operation, the patient remained healthy until cancer re-occurred. This time radiotherapy was performed, resulting in the complete tumour regression. And 10 years post-operation, in 2018, cancer was diagnosed in the left lung — this time it was the invasive highly differentiated squamous non-keratinized carcinoma. Radio- and chemotherapy yielded positive results.

Although the patient underwent several operations, radio- and chemotherapy, and tuberculosis treatment, he continues to live a normal, healthy life. This would have been impossible without the surgery — difficult and rare, but lifesaving.

There exist many ways of performing tracheal resection, but very few studies have reported success when more than 50% of the trachea is involved. In the case presented by Sechenov doctors, there was a strict limit of the possible expansion of the resection zone during the removal of the right lung. The favourable outcome of this surgery highlights the dedication of Sechenov University to deliver the best quality of medical care, along with its research mission.

The study was carried out primarily by the Department of Phthisiopulmonology and Thoracic Surgery, Sechenov University, and supported by the 5-100 Russian Academic Excellence Project.

Read more: Giller D, Giller B, Scherbakova G et al. Extensive tracheal resection in lung cancer and tuberculosis: a case report. BMC Pulm Med (2020).

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