Evaluating the Effectiveness of Thoracoscopic Intervention for Pulmonary Abscess: Is Lobectomy the Optimal Solution After Medical Therapy Fails?

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Po-Keng Su, Shun-Mao Yang, Cheng-Hung How, Chao-Yu Liu, Ka-I Leong, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6426084/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Oct, 2025 Read the published version in BMC Surgery → Version 1 posted 10 You are reading this latest preprint version Abstract Background : Lung abscess is typically managed by performing abscess drainage. While pulmonary resection effectively controls infection, its role in eliminating necrotic tissue remains debatable due to risks such as bleeding, desaturation, systemic inflammation, persistent air leakage, and bronchopleural fistula. In this study, we evaluated the outcomes of pulmonary resection for lung abscess refractory to medical therapy. Methods : We retrospectively analyzed 70 patients who underwent salvage thoracoscopic surgery for lung abscess, along with 60 days’ follow-up, at a tertiary referral hospital between January 2016 and August 2022. Thirty-two patients underwent lobectomy, while 38 did not. The patients’ demographics, comorbidities, disease progression, 30-day and 60-day mortality, and operative morbidity were compared between the lobectomy and non-lobectomy groups. Results : Necrotizing pneumonia was the leading cause of lung abscess (n=53, 75.7%), with empyema being the most common sign of disease progression (n=36, 51.4%). The lobectomy group had a lower mortality rate compared with the non-lobectomy group (15.6% vs 36.8%, p =0.047). Multivariate analysis identified a higher Charlson Comorbidity Index (CCI) as a risk factor for 30-day mortality (HR=1.286, 95% CI=1.059–1.561; p =0.011), while lobectomy mitigated the 30-day mortality risk (HR=0.255, 95% CI=0.068–0.959; p =0.043). Similarly, a higher CCI augmented the 60-day mortality risk (HR=1.317, 95% CI=1.105–1.571; p =0.002), whereas lobectomy lowered it (HR=0.319, 95% CI=0.110–0.921; p =0.035). Conclusion : Lobectomy significantly improves the 30- and 60-day mortality outcomes compared to non-lobectomy surgery, making it a viable option for pharmacotherapy-refractory lung abscess. Lobectomy Lung abscess Mortality Pulmonary abscess drainage Pulmonary resection Figures Figure 1 1. Background Lung abscess, necrotizing pneumonia, and pulmonary gangrene are pulmonary infections that differ with respect to the degree of inflammation, necrosis, and parenchymal destruction [ 1 ]. Lung abscess is characterized by the formation of a cavity filled with necrotic debris, infectious and inflammatory tissues, and even pus within the lung parenchyma [ 2 , 3 ]. Parenchymal consolidation containing air and fluid, surrounded by peripheral necrosis is a typical chest computed tomography (CT) finding of a lung abscess [ 4 ]. Etiologically, lung abscess can be classified as primary or secondary. Primary lung abscess occurs due to aspiration of oropharyngeal and gastrointestinal secretions, pneumonia, and immunodeficiency. Secondary lung abscesses arise from coexisting lung diseases (cystic fibrosis, bronchiectasis, bullous emphysema, or infected pulmonary infarcts), bronchial obstruction (related to tumor, foreign body, or mediastinal mass), spread of infection from direct and indirect sites (hematogenous, subphrenic abscess, or broncho-esophageal fistula), and congenital malformation [ 3 , 5 ]. The clinical signs and treatment of lung abscess were first described by Hippocrates; however, an effective surgical intervention for lung abscesses was not clearly established at that time. In the pre-antibiotic era, approximately 100 years ago, lung abscess was often fatal, with mortality rates reportedly as high as 75% [ 6 , 7 ]. In the early decades of the twentieth century, Neuhof and Hurwitt [ 8 ] pioneered a novel and reliable therapeutic concept for lung abscess: the one-stage open drainage operation. This procedure was performed in a series of 162 cases, reducing the mortality rate to 2.47%. Between the 1940s and 1950s, several studies proposed the use of pulmonary resection, including lobectomy and pneumonectomy, to treat patients with lung abscess refractory to initial medical treatment [ 9 – 11 ]. Surgical interventions were administered to patients who experienced disease progression to empyema, hemoptysis, septic shock, or progressive respiratory distress despite initial therapy. Adding surgery to the treatment regimen aimed to remove permanently damaged lung parenchyma that could harbor recurrent infections and was considered in cases where conservative treatments alone were insufficient. Lung resection for lung abscess remains feasible in patients who do not respond to other treatments, and lobectomy or segmentectomy can be performed safely, with minimal morbidity and mortality [ 12 , 13 ]. In our single-center, retrospective study, we examined 70 patients with lung abscess who underwent thoracoscopic surgical intervention, with the aim of identifying the predictors of outcome and mortality. 2. Materials and methods 2.1. Eligibility criteria The data of 628 patients who underwent video-assisted thoracic surgery (VATS) for empyema and lung abscess at our institution between January 2016 to August 2022 were reviewed retrospectively. The eligibility criteria for patient selection are shown in Fig. 1 . The inclusion criteria were patients: (1) aged ≥ 18 years; (2) diagnosed with lung abscess and empyema using the International Classification of Diseases-10 diagnostic codes; and (3) who underwent surgery including decortication, unroofing, wedge resection, segmentectomy, lobectomy, bilobectomy, and pneumonectomy. Patients were excluded if they had: (1) simple empyema without lung abscess (chest CT did not depict lung abscess or obvious cavity formation and fluid-filled central necrosis was absent); (2) no evidence of inflammation, necrosis, infection, abscess, or empyema on the pathological reports; (3) chest wall abscess; and (4) no surgical intervention (e.g., bronchoscopy). The study was approved by the Institutional Review Board (IRB) of Far Eastern Memorial Hospital (IRB approval no. 111279-E), which waived the need for informed consent. 2.2. Preoperative assessment All patients were treated by three attending thoracic surgeons at the Far Eastern Memorial Hospital, New Taipei City, Taiwan. Chest CT was performed for all patients to evaluate the extent of lung infection. We retrospectively reviewed the following clinical data: age, sex, comorbidity [Charlson Comorbidity Index (CCI)], smoking history, disease progression, etiology of lung abscess [ 3 ], and abscess location and size. In patients with comorbidity or disease progression, respiratory insufficiency referred to increased oxygen demand under initial treatment, respiratory failure was defined as ventilator use, and bilateral pneumonia implied that infection could not be controlled by medical treatment [ 12 ]. 2.3. Operative technique All patients underwent VATS in the operating room under general anesthesia and lung isolation with a double-lumen or single-lumen endotracheal tube with blocker intubation. Patients were placed in the decubitus position during the procedure. Some patients underwent only decortication, whereas others underwent additional procedures such as wedge resection and lobectomy to eradicate the infectious foci. No patient underwent pneumonectomy and bilobectomy. If patients underwent lobectomy using another procedure, they were categorized into the lobectomy group. We also confirmed lung re-expansion during operation by using two-lung ventilation and inserting one or two chest tubes via the ports. 2.4. Surgical outcomes We obtained patients’ basic data from their electronic medical records. After surgery, we analyzed their morbidity (Clavien-Dindo classification and the number of patients with grade ≥ 3B), length of intensive care unit (ICU) stay (days), and 30-day and 60-day mortality. We used univariate and multivariate Cox proportional modeling to analyze the outcomes to determine the predictive factors associated with 30-day and 60-day mortality. 2.5. Statistical analysis The normality of numerical data was assessed using the Shapiro–Wilk test. Normally distributed numerical data were expressed as means ± standard deviations, whereas non-normally distributed data were presented as medians (Q1, Q3). Categorical data were presented as frequencies and percentages. Statistical differences between groups were examined using the independent t-test/Mann–Whitney U test or chi-squared/Fisher’s exact test, as appropriate, depending on the characteristics of the data. The 30-day mortality and 60-day mortality were estimated using Kaplan–Meier analysis, and the differences between the lobectomy and non-lobectomy groups were analyzed using the log-rank test. The effect of lobectomy on mortality was analyzed using univariate and multivariate Cox proportional hazard regression. All statistical analyses were performed using IBM SPSS Statistics software version 22.0, with statistical significance between/among groups set at p < 0.05. 3. Results We divided 70 patients who underwent surgical intervention for lung abscesses into two groups based on the operative procedures. Thirty-two underwent lobectomy (lobectomy group) and the remaining 38 patients underwent surgery without lobectomy (non-lobectomy group). The patients’ demographic features are summarized in Table 1 . Fifty-six (80%) patients were men. The average age was 58.06 (± 15.9) years in the lobectomy group and 61.21 (± 11.3) years in the non-lobectomy group. Fourteen (43.8%) and 26 (68.4%) patients in the lobectomy and non-lobectomy groups reported a history of smoking, respectively ( p < 0.05). The Mann–Whitney U test did not reveal significant differences in the comorbidities and CCI between the two groups [lobectomy: 2.0 (1.0, 5.0); non-lobectomy: 3.5 (2.0, 5.0); p = 0.329]. We also divided lung abscess into primary and secondary based on etiology. Necrotizing pneumonia was the most common etiology of primary lung abscess, while tumor obstruction was the most common etiology of secondary lung abscess. Empyema was the most common progressive sign in both groups, whose frequency was significantly greater in the non-lobectomy group than in the lobectomy group (65.8% vs 34.4%; p = 0.009). Respiratory insufficiency and bilateral pneumonia were the second and third most common signs of disease progression in both groups, respectively. Lung abscess occurred most commonly in the right lower lobe, and the location did not differ between the two groups. The size of the lung abscess did not differ significantly between the lobectomy (7.1 ± 2.8 cm) and non-lobectomy groups (5.98 ± 2.3 cm). Table 1 Demographic data and characteristics of patients who underwent operation for lung abscess. Lobectomy (n = 32) Non-lobectomy (n = 38) p value Age (min-max) 58.06 ± 15.9 (29–85) 61.21 ± 11.3 (40–89) 0.352 Sex (M:F) 24:8 32:6 0.337 Smoking 14 (43.8) 26 (68.4) 0.038 Comorbidity None 11 (34.4) 9 (23.7) 0.324 Hypertension 12 (37.5) 13 (34.2) 0.775 Diabetes mellitus 8 (25) 12 (31.6) 0.544 Chronic obstructive pulmonary disease 4 (12.5) 2 (5.3) 0.402 Lung cancer 1 (3.1) 1 (2.6) 1.000 Other malignancies 6 (18.8) 7 (18.4) 0.972 Coronary artery disease 4 (12.5) 8 (21.1) 0.526 Cerebrovascular accident 3 (9.4) 9 (23.7) 0.202 Lung disease 4 (12.5) 2 (5.3) 0.402 Chronic kidney disease 2 (6.3) 3 (7.9) 1.000 Charlson Comorbidity Index† 2.0 (1.0, 5.0) 3.5 (2.0, 5.0) 0.329 Etiology Primary Necrotizing pneumonia 21 (65.6) 32 (84.2) 0.071 Aspiration 0 (0) 2 (5.3) 0.496 immunodeficiency 1 (3.1) 2 (5.3) 1.000 Secondary Tumor obstruction 3 (9.4) 1 (2.6) 0.325 Foreign body obstruction 2 (6.3) 0 (0) 0.205 Bronchiectasis 1 (3.1) 0 (0) 0.457 Cystic fibrosis 1 (3.1) 0 (0) 0.457 Bullous emphysema 1 (3.1) 0 (0) 0.457 Subphrenic infection 0 (0) 1 (2.6) 1.000 Pulmonary infarct 1 (3.1) 0 (0) 0.457 Congenital malformation 1 (3.1) 0 (0) 0.457 Comorbidity or progression of disease Empyema 11 (34.4) 25 (65.8) 0.009 Respiratory insufficiency 11 (34.4) 9 (23.7) 0.324 Bilateral pneumonia 8 (25) 10 (26.3) 0.9 Hemoptysis 7 (21.9) 1 (2.6) 0.02 Septic shock 2 (6.3) 5 (13.2) 0.442 Respiratory failure 1 (3.1) 7 (18.4) 0.063 Air leakage 1 (3.1) 2 (5.3) 1.000 Location 0.906 Right upper lobe 5 (15.6) 5 (13.2) Right middle lobe 2 (6.3) 1 (2.6) Right lower lobe 10 (31.3) 15 (39.5) Left upper lobe 6 (18.8) 6 (15.8) LLL 9 (28.1) 11 (28.9) Size (min-max) 7.1 ± 2.8 (2.5–12.5) 5.98 ± 2.3 (2.7–9.3) 0.07 †The difference in the Charlson Comorbidity Index between the lobectomy and non-lobectomy groups was analyzed using the Mann–Whitney test. [Table 1 near here] The 30-day mortality and 60-day mortality of the two groups are presented in Fig. 2 . The 30-day survival and 60-day survival were plotted as Kaplan–Meier curves, which revealed that survival was longer in the lobectomy group (30-day mortality: p = 0.044 and 60-day mortality: p = 0.048, respectively). Table 2 describes the postoperative outcomes in this study. The rate of morbidity did not differ significantly between the two groups [16 (50%) vs 23 (60.5%); p = 0.377]. Pneumonia was the most common morbidity in both groups. Atrial fibrillation occurred only in the lobectomy group, but the difference with the non-lobectomy group lacked statistical significance. We used the Clavien-Dindo classification to grade the severity of surgical complications and found that the frequency of severe complications (Clavien-Dindo grade ≥ 3B) was greater in the non-lobectomy group than in the lobectomy group (25% vs 50%; p = 0.032). The length of ICU stay did not differ significantly between the two groups. We also compared the number of days on postoperative ventilation, and excluded (i) initial ventilation before surgery, (ii) transfer to the respiratory care ward for further care, and (iii) death after surgery. Extended use of ventilation was not required in the lobectomy group. Table 2 Postoperative morbidity and outcomes. Lobectomy (n = 32) Non-lobectomy (n = 38) p value Mortality (%) 5 (15.6) 14 (36.8) 0.047 Morbidity (%) 16 (50) 23 (60.5) 0.377 Atelectasis 7 (21.9) 11 (28.9) 0.5 Pneumonia 9 (28.1) 15 (39.5) 0.319 Pleural effusion 5 (15.6) 9 (23.7) 0.401 Prolonged air leakage 4 (12.5) 5 (13.2) 1.000 Atrial fibrillation 5 (15.6) 0 (0) 0.017 Bronchial injury 1 (3.1) 0 (0) 0.457 Wound infection 0 (0) 1 (2.6) 1.000 Fungemia 0 (0) 1 (2.6) 1.000 Ventricular tachycardia 1 (3.1) 0 (0) 0.457 Clavien-Dindo classification ≥ 3B (%) 8 (25) 19 (50) 0.032 Length of ICU stay (days) [median (Q1, Q3)]† 5.0 (3.00, 13.75) 6.0 (3.00, 16.25) 0.741 Days of postoperative ventilation†‡ [median (Q1, Q3)] (n = 22) 1.0 (1.0, 6.5) (n = 23) 1.0 (1.0, 4.0) 0.913 †The differences in the length of ICU stay and days on postoperative ventilation between the lobectomy and non-lobectomy groups were analyzed using the Mann–Whitney test. ‡The data regarding days on postoperative ventilation exclude (i) initial ventilation before surgery, (ii) transfer to the respiratory care ward for further care, and (iii) death after surgery. ICU: intensive care unit. [Table 2 near here] In our study, the Cox proportional hazard model (Table 3 ) was used to analyze the outcomes in all patients. Multivariate analyses of 30- and 60-day mortality revealed that surgery with lobectomy was an independent factor that enhanced survival and that a higher CCI was a risk factor for higher mortality in patients with lung abscess. Table 3 Cox proportional hazard model of 30-day and 60-day mortality for patients undergoing surgery for lung abscess Variable Univariate Multivariate HR (95% CI) p value HR (95% CI) p value 30-day mortality Surgery with lobectomy 0.293 (0.082–1.053) 0.06 0.255 (0.068–0.959) 0.043 Age 1.024 (0.985–1.064) 0.237 0.985 (0.931–1.043) 0.603 Sex 0.897 (0.250–3.215) 0.867 Smoking 1.319 (0.442–3.936) 0.620 Size ≥ 5 cm 0.512 (0.177–1.477) 0.216 0.640 (0.202–2.027) 0.448 Charlson Comorbidity Index 1.268 (1.080–1.488) 0.004 1.286 (1.059–1.561) 0.011 Empyema 0.931 (0.326–2.654) 0.893 0.663 (0.224–1.964) 0.458 60-day mortality Surgery with lobectomy 0.372 (0.134–1.035) 0.058 0.319 (0.110–0.921) 0.035 Age 1.027 (0.993–1.062) 0.120 0.992 (0.945–1.041) 0.734 Sex 0.905 (0.300–2.729) 0.860 Smoking 1.632 (0.620–4.295) 0.321 Size ≥ 5 cm 0.633 (0.249–1.610) 0.337 0.867 (0.306–2.462) 0.789 Charlson Comorbidity Index 1.294 (1.120–1.496) < 0.001 1.317 (1.105–1.571) 0.002 Empyema 0.831 (0.337–2.044) 0.686 0.622 (0.245–1.580) 0.318 [Table 3 near here] 4. Discussion In the current era, mortality due to lung abscess has declined substantially because of the advent of potent antibiotic therapy and the concept of drainage and intervention [ 6 , 8 ]. However, despite this decline, the mortality rate remains unsatisfactory, ranging between 15% and 20% in recent years [ 14 – 16 ]. Lung abscess is often accompanied by other complications, and disease progression not only prolongs hospitalization but also encumbers treatment. Zhang et al. suggested the following indications for surgical intervention for lung abscess: treatment failure after intensive medical management, bronchopleural fistula, lung abscess > 6 cm in diameter, and severe or life-threatening hemoptysis [ 2 ]. Diffuse destruction of the lung parenchyma may cause vascular insufficiency, limiting the delivery of antibiotics, and obstruction of the bronchus make hinder expectoration of the necrotic material [ 17 , 19 ]. Hence, complete eradication of the focus of infection may be a feasible choice in the event of failure of medical treatment for lung abscess. Lung abscess is highly concomitant with empyema. Cai et al. [ 20 ] indicated that the risk of empyema was significantly higher for patients with pulmonary abscess measuring ≥ 5 cm than for patients with smaller abscesses. Surgical intervention is often indicated in symptomatic patients with empyema, for which previous studies have reported satisfactory outcomes [ 21 , 22 ]. However, if the empyema is related to lung abscess, the ICU admission and mortality rates are higher, with a trend toward second surgical intervention [ 23 ]. In these cases, decortication or partial lung resection may afford insufficient infection control. In our study, age did not differ significantly between the two groups, while male preponderance was observed in the entire lung abscess cohort. We used the CCI to measure patients’ comorbidities [ 24 ], and analyzed the etiology of lung abscess [ 3 , 12 ]. Previous studies indicated that pulmonary malignancy was a poor predictor for lung abscess, and excluded it from the prognostication process [ 22 , 25 ]. However, in the acute phase, the primary aim is to keep patients alive before further treatment; thus, we included these patients to analyze the short-term outcomes. Empyema was the most common sign of disease progression in our study, and a previous study also indicated poor outcomes for concomitant lung abscess and empyema [ 23 ]. In the current study, we performed decortication to excise “the peel” to facilitate sufficient lung expansion and evaluated the possibility of lobectomy in patients with empyema. However, since empyema hindered the approach to the bronchus and vessels, the number of patients with empyema was higher in the non-lobectomy group. Hemoptysis and air leakage often necessitate surgical treatment. We tended to perform lobectomy in patients with massive hemoptysis to remove the affected lobe and potentially eliminate the source of bleeding ( p = 0.02). In this study, the right lower lobe was the most common site of lung abscess, although the location of the lung abscess did not differ significantly between the two groups. We acquired chest CT in all patients before surgery and recorded the maximum diameter of the abscess cavity to determine its size. The lung abscess cavity size in the lobectomy group was larger than in the non-lobectomy group, albeit without statistical significance. The mortality rate for lung abscess accompanied by empyema exceeds 20% [ 23 ]. The mortality rate in our series was higher than that of previous studies, which could hypothetically be attributed to the larger abscess size and severe comorbidities in our patients. All patients underwent follow-up chest X-rays regularly after surgery. Persistent or progressive pneumonia was the most common post-surgical morbidity. We used the Clavien-Dindo classification to assess the surgical complications [ 26 ]. Although the morbidity rate did not differ significantly between the two groups in our study, the rate of Clavien-Dindo grade 3B was greater in the non-lobectomy group. Since we performed decortication or partial lung resection in the non-lobectomy group, the infectious source could not be eliminated completely. Damaged residual lung parenchyma could be a nidus for persistent or recurrent infections, necessitating further operation to control infection. No significant difference was noted with respect to the ICU stay and days on postoperative ventilation between the two groups. We analyzed the 30-day and 60-day mortality using Kaplan–Meier analysis, which revealed that the lobectomy group had a significantly better survival rate. Previous studies have reported that ventilator use, concomitant empyema, septic shock, and preexisting comorbidity are among the risk factors for lung abscess [ 1 , 12 , 23 , 27 ]. Our study showed that the outcomes are affected by the underlying comorbidity and operation method. We hypothesized that lobectomy could eliminate the damaged lung parenchyma completely in cases that are refractory to antibiotic treatment and can also avert empyema development. The underlying comorbidity is an obvious risk factor for lung abscess, consistent with previous studies. We have summarized the details of past studies on surgery for lung abscess in Table 4 . All these studies were retrospective in design and described the indications for surgery and the surgical procedure. Empyema was the most common progressive symptom in two cohorts [ 1 , 4 ], and the second most common symptom in other two cohorts [ 12 , 27 ]. According to those studies, empyema in patients with lung abscess often required surgical intervention, and lobectomy was the most common surgical strategy. The mortality rate ranged from 8.5–15.4%, and the predictive factors included ventilator use, underlying disease, sepsis, and organ failure. In our study population, we recorded the size of the abscess, and our data illustrated that lobectomy could improve the outcome. However, the mortality rate was higher than that reported by previous studies. Table 4 Details of past studies on surgery for lung abscess. Authors/years (country) Study type Sample size Indications for surgery Surgical procedures Morbidity Mortality Risk factors Reimel et al., 2006 (USA) [ 1 ] Retrospective 35 Empyema, n = 17 Hemoptysis, n = 5 Air leakage, n = 7 Septic shock, n = 8 Respiratory distress, n = 7 Pneumonectomy, n = 4 Lobectomy, n = 18 Segmentectomy, n = 2 Wedge resection, n = 4 Debridement, n = 7 Wound infection, n = 1 Bronchial stump leak, n = 1 Postoperative empyema, n = 4 Cardiovascular instability, n = 1 3 (8.5%) Ventilator use (-) Krishnadasan et al., 2000 (USA) [ 4 ] Retrospective 5 Bronchopleural fistula, n = 2 Empyema, n = 3 Hemoptysis, n = 1 Pneumonectomy, n = 1 Bilobectomy, n = 1 Lobectomy, n = 2 Wedge resection, n = 1 Postoperative empyema, n = 2 N/A N/A Tsai et al., 2011 (Taiwan) [ 12 ] Retrospective 26 Progressive respiratory distress, n = 17 Empyema, n = 12 Bronchopleural fistula, n = 5 Septic shock, n = 4 Hemoptysis, n = 3 Bilateral pneumonia, n = 2 Wedge resection, n = 1 Lobectomy, n = 19 Bilobectomy, n = 6 Progressing pulmonary infection, n = 3 Postoperative empyema, n = 3 4 (15.4%) Underlying diseases (-) Schweigert et al., 2017 (Germany) [ 27 ] Retrospective 91 Pulmonary sepsis, n = 48 Empyema, n = 43 Persistent air leakage, n = 25 Acute renal failure, n = 12 Respiratory failure, n = 25 Segmentectomy, n = 18 Lobectomy, n = 58 Pneumonectomy, n = 15 N/A 13 (14.3%) Pulmonary sepsis (-) Septic organ failure (-) Preexisting comorbidity (-) Our study Retrospective 70 Same as Table 1 Lobectomy, n = 32 Non-lobectomy, n = 38 Same as Table 2 . 19 (27.1%) Lobectomy (+) Preexisting comorbidity (-) [Table 4 near here] The limitations of our study should be acknowledged. First, the study was retrospective in design. Second, lung function testing should have been performed before and after lobectomy to evaluate the change in lung volume. However, since all of our patients underwent emergency operations, data on lung function were insufficient for analysis. Third, we did not perform long-term follow-up after the surgical procedures. This was a single-center experience, and we endeavor to accrue more comprehensive data in the future. To date, surgical intervention for lung abscesses lacks unanimous consensus, and we hope that future studies can establish categorical and clear criteria. 5. Conclusions Surgical intervention for lung abscess refractory to pharmacotherapy remains controversial. We analyzed the predictive factors for mortality in patients who underwent surgical interventions and found that thoracoscopic lobectomy could significantly improve mortality compared to other interventions. Hence, thoracoscopic lobectomy may be an effective and feasible treatment option for lung abscess recalcitrant to medical treatment. Abbreviations CCI Charlson Comorbidity Index CT computed tomography ICU intensive care unit VATS video-assisted thoracoscopic surgery Declarations Acknowledgements Not applicable. Funding This study did not receive any external funding. Authorship contribution statement Po-Keng Su: Conception and design of the study; Acquisition of data (laboratory or clinical); Data analysis and/or interpretation; Drafting of manuscript and/or critical revision; Approval of the final version of the manuscript. Shun-Mao Yang: Conception and design of the study; Data analysis and/or interpretation; Drafting of manuscript and/or critical revision; Approval of the final version of the manuscript. Cheng-Hung How: Conception and design of study; Acquisition of data (laboratory or clinical); Data analysis and/or interpretation; Drafting of manuscript and/or critical revision; Approval of the final version of the manuscript. Chao-Yu Liu: Acquisition of data (laboratory or clinical); Approval of the final version of the manuscript. Ka-I Leong: Acquisition of data (laboratory or clinical); Approval of the final version of the manuscript. Jei-Kuo Lin: Acquisition of data (laboratory or clinical); Approval of the final version of the manuscript. San-Fang Chou: Conception and design of study; Data analysis and/or interpretation. Corresponding author Correspondence to Shun-Mao Yang, and Cheng-Hung How. Ethics declarations Ethics approval and consent to participate This study was performed in line with the principles of the Declaration of Helsinki. This study was initiated by the Far Eastern Memorial Hospital. The study was approved by the Institutional Review Board (IRB) of Far Eastern Memorial Hospital (IRB approval no. 111279-E), which waived the need for informed consent. Consent for publication All authors in our study group agreed on the order of authorship and publication. Competing interests All authors have no conflict of interest. Data availability The datasets generated during this study will be available from the corresponding author on reasonable request after the publication of the main findings. References Reimel BA, Krishnadasen B, Cuschieri J, Klein MB, Gross J, Karmy-Jones R. Surgical management of acute necrotizing lung infections. Can Respir J. 2006;13:369–73. https://doi.org/10.1155/2006/760390. Zhang JH, Yang SM, How CH, Ciou YF. Surgical management of lung abscess: from open drainage to pulmonary resection. J Vis Surg. 2018;4:224. https://doi.org/10.21037/jovs.2018.10.14. Kuhajda I, Zarogoulidis K, Tsirgogianni K, Tsavlis D, Kioumis I, Kosmidis C, et al. Lung abscess-etiology, diagnostic and treatment options. Ann Transl Med. 2015;3:183. https://doi.org/10.3978/j.issn.2305-5839.2015.07.08. Krishnadasan B, Sherbin VL, Vallières E, Karmy-Jones R. Surgical management of lung gangrene. Can Respir J. 2000;7:401–4. https://doi.org/10.1155/2000/174703. Puligandla PS, Laberge JM. Respiratory infections: pneumonia, lung abscess, and empyema. Semin Pediatr Surg. 2008;17:42–52. https://doi.org/10.1053/j.sempedsurg.2007.10.007. Schweigert M, Dubecz A, Stadlhuber RJ, Stein HJ, Neuhof H. Modern history of surgical management of lung abscess: from Harold Neuhof to current concepts. Ann Thorac Surg. 2011;92:2293–7. https://doi.org/10.1016/j.athoracsur.2011.09.035. Lord FT. Certain aspects of pulmonary abscess, from analysis of 227 cases. Boston Med Surg J. 1925;192:785–8. https://doi.org/10.1056/NEJM192504231921701. Neuhof H, Hurwitt E. Acute putrid abscess of the lung: VII. Relationship of the technic of the one-stage operation to results. Ann Surg. 1943;118:656–64. https://doi.org/10.1097/00000658-194310000-00014. Shaw RR, Paulson DL. Pulmonary resection for chronic abscess of the lung. J Thorac Surg. 1948;17:514–22. https://doi.org/10.1016/S0096-5588(20)31860-2. Myers RT, Bradshaw HH. Conservative resection of chronic lung abscess. Ann Surg. 1950;131:985–93. https://doi.org/10.1097/00000658-195006000-00019. Waterman DH, Domm SE. Changing trends in the treatment of lung abscess. Dis Chest. 1954;25:40–53. https://doi.org/10.1378/chest.25.1.40. Tsai YF, Tsai YT, Ku YH. Surgical treatment of 26 patients with necrotizing pneumonia. Eur Surg Res. 2011;47:13–8. https://doi.org/10.1159/000327684. Mitchell JD, Yu JA, Bishop A, Weyant MJ, Pomerantz M. Thoracoscopic lobectomy and segmentectomy for infectious lung disease. Ann Thorac Surg. 2012;93:1033–9; discussion 1039–40. https://doi.org/10.1016/j.athoracsur.2012.01.012. Hirshberg B, Sklair-Levi M, Nir-Paz R, Ben-Sira L, Krivoruk V, Kramer MR. Factors predicting mortality of patients with lung abscess. Chest. 1999;115:746–50. https://doi.org/10.1378/chest.115.3.746. Pohlson EC, McNamara JJ, Char C, Kurata L. Lung abscess: a changing pattern of the disease. Am J Surg. 1985;150:97–101. https://doi.org/10.1016/0002-9610(85)90016-9. Wali SO. An update on the drainage of pyogenic lung abscesses. Ann Thorac Med. 2012;7:3–7. https://doi.org/10.4103/1817-1737.91552. Curry CA, Fishman EK, Buckley JA. Pulmonary gangrene: radiological and pathologic correlation. South Med J. 1998;91:957–60. https://doi.org/10.1097/00007611-199810000-00012. Phillips LG, Rao KV. Gangrene of the lung. J Thorac Cardiovasc Surg. 1989;97:114–8. https://doi.org/10.1016/S0022-5223(19)35135-9. Hoffer FA, Bloom DA, Colin AA, Fishman SJ. Lung abscess versus necrotizing pneumonia: implications for interventional therapy. Pediatr Radiol. 1999;29:87–91. https://doi.org/10.1007/s002470050547. Cai XD, Yang Y, Li J, Liao X, Qiu S, Xu J, et al. Logistic regression analysis of clinical and computed tomography features of pulmonary abscesses and risk factors for pulmonary abscess-related empyema. Clinics (Sao Paulo). 2019;74:e700. https://doi.org/10.6061/clinics/2019/e700. Redden MD, Chin TY, van Driel ML. Surgical versus non-surgical management for pleural empyema. Cochrane Database Syst Rev. 2017;3:CD010651. https://doi.org/10.1002/14651858.CD010651.pub2. Wilshire CL, Jackson AS, Meggyesy AM, Buehler KE, Chang SC, Horslen LC, et al. Comparing initial surgery versus fibrinolytics for pleural space infections: a retrospective multicenter cohort study. Ann Am Thorac Soc. 2022;19:1827–33. https://doi.org/10.1513/AnnalsATS.202108-964OC. Huang HC, Chen HC, Fang HY, Lin YC, Wu CY, Cheng CY. Lung abscess predicts the surgical outcome in patients with pleural empyema. J Cardiothorac Surg. 2010;5:88. https://doi.org/10.1186/1749-8090-5-88. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83. https://doi.org/10.1016/0021-9681(87)90171-8. Mwandumba HC, Beeching NJ. Pyogenic lung infections: factors for predicting clinical outcome of lung abscess and thoracic empyema. Curr Opin Pulm Med. 2000;6:234–9. https://doi.org/10.1097/00063198-200005000-00012. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96. https://doi.org/10.1097/SLA.0b013e3181b13ca2. . Schweigert M, Solymosi N, Dubecz A, John J, West D, Boenisch PL, et al. Predictors of outcome in modern surgery for lung abscess. Thorac Cardiovasc Surg. 2017;65:535–41. https://doi.org/10.1055/s-0037-1598113. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 17 Oct, 2025 Read the published version in BMC Surgery → Version 1 posted Editorial decision: Revision requested 14 May, 2025 Reviews received at journal 12 May, 2025 Reviewers agreed at journal 05 May, 2025 Reviews received at journal 03 May, 2025 Reviewers agreed at journal 02 May, 2025 Reviewers invited by journal 30 Apr, 2025 Editor assigned by journal 30 Apr, 2025 Editor invited by journal 21 Apr, 2025 Submission checks completed at journal 18 Apr, 2025 First submitted to journal 18 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6426084","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":452265778,"identity":"ab902ae4-db50-4096-8bb9-ce5dd7b3634c","order_by":0,"name":"Po-Keng Su","email":"","orcid":"","institution":"Far Eastern Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Po-Keng","middleName":"","lastName":"Su","suffix":""},{"id":452265779,"identity":"6bedd4de-f8cf-413c-b0db-c39f996ee3b7","order_by":1,"name":"Shun-Mao Yang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYDADfhCRUECUWmYIJdkA0mJAihaDA2CSCA26M/IPfuapuWO3+fzqxA8PDBjk+cUO4NdidiOZWZrn2LPkbTfebpYAOsxw5uwEgloYpHnYDieb3Ti7AaQlweA2YS3Mv3n+HU42nnF28w9itbBJ87YdtjPg791GpC1nHptZzu07nCBxg3ebRYKBBBF+OZ74+Mabb4ft+fvPbr75o8JGnl+agBYQYOJhYEhskACrlCCsHAQYfzAw2DPwHyBO9SgYBaNgFIw8AACV7UdzugYq7QAAAABJRU5ErkJggg==","orcid":"","institution":"National Taiwan University Hospital, Hsin-Chu Branch","correspondingAuthor":true,"prefix":"","firstName":"Shun-Mao","middleName":"","lastName":"Yang","suffix":""},{"id":452265780,"identity":"069d0f51-c79f-4640-8941-b3ee4a364f7c","order_by":2,"name":"Cheng-Hung How","email":"","orcid":"","institution":"Far Eastern Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Cheng-Hung","middleName":"","lastName":"How","suffix":""},{"id":452265781,"identity":"90943cd7-1a6a-48fe-8621-7f2ed32a4077","order_by":3,"name":"Chao-Yu Liu","email":"","orcid":"","institution":"Far Eastern Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chao-Yu","middleName":"","lastName":"Liu","suffix":""},{"id":452265782,"identity":"9f21ab4d-0bc9-4090-b917-b21bdf00015c","order_by":4,"name":"Ka-I Leong","email":"","orcid":"","institution":"Far Eastern Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ka-I","middleName":"","lastName":"Leong","suffix":""},{"id":452265783,"identity":"baa4434e-627d-4ce3-b5ca-42c2fa01b726","order_by":5,"name":"Jei-Kuo Lin","email":"","orcid":"","institution":"Far Eastern Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jei-Kuo","middleName":"","lastName":"Lin","suffix":""},{"id":452265784,"identity":"d3ad1252-9a39-4fd3-9fec-926ef332d4d4","order_by":6,"name":"San-Fang Chou","email":"","orcid":"","institution":"Far Eastern Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"San-Fang","middleName":"","lastName":"Chou","suffix":""}],"badges":[],"createdAt":"2025-04-11 07:53:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6426084/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6426084/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12893-025-03167-2","type":"published","date":"2025-10-17T15:56:55+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82300810,"identity":"3f5a7a4d-e1fc-4822-8c48-6e89aa449d0e","added_by":"auto","created_at":"2025-05-08 20:50:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":114694,"visible":true,"origin":"","legend":"\u003cp\u003ePatient allocation and exclusion.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6426084/v1/60210672796b97ecea5ebd45.png"},{"id":93956796,"identity":"7f12e2c4-05f5-4b07-b16f-4154a216d72b","added_by":"auto","created_at":"2025-10-20 16:12:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":967352,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6426084/v1/2e414a01-dc6f-42cc-9cf2-81027e2bff5a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluating the Effectiveness of Thoracoscopic Intervention for Pulmonary Abscess: Is Lobectomy the Optimal Solution After Medical Therapy Fails?","fulltext":[{"header":"1. Background","content":"\u003cp\u003eLung abscess, necrotizing pneumonia, and pulmonary gangrene are pulmonary infections that differ with respect to the degree of inflammation, necrosis, and parenchymal destruction [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Lung abscess is characterized by the formation of a cavity filled with necrotic debris, infectious and inflammatory tissues, and even pus within the lung parenchyma [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Parenchymal consolidation containing air and fluid, surrounded by peripheral necrosis is a typical chest computed tomography (CT) finding of a lung abscess [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Etiologically, lung abscess can be classified as primary or secondary. Primary lung abscess occurs due to aspiration of oropharyngeal and gastrointestinal secretions, pneumonia, and immunodeficiency. Secondary lung abscesses arise from coexisting lung diseases (cystic fibrosis, bronchiectasis, bullous emphysema, or infected pulmonary infarcts), bronchial obstruction (related to tumor, foreign body, or mediastinal mass), spread of infection from direct and indirect sites (hematogenous, subphrenic abscess, or broncho-esophageal fistula), and congenital malformation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe clinical signs and treatment of lung abscess were first described by Hippocrates; however, an effective surgical intervention for lung abscesses was not clearly established at that time. In the pre-antibiotic era, approximately 100 years ago, lung abscess was often fatal, with mortality rates reportedly as high as 75% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In the early decades of the twentieth century, Neuhof and Hurwitt [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] pioneered a novel and reliable therapeutic concept for lung abscess: the one-stage open drainage operation. This procedure was performed in a series of 162 cases, reducing the mortality rate to 2.47%.\u003c/p\u003e \u003cp\u003eBetween the 1940s and 1950s, several studies proposed the use of pulmonary resection, including lobectomy and pneumonectomy, to treat patients with lung abscess refractory to initial medical treatment [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Surgical interventions were administered to patients who experienced disease progression to empyema, hemoptysis, septic shock, or progressive respiratory distress despite initial therapy. Adding surgery to the treatment regimen aimed to remove permanently damaged lung parenchyma that could harbor recurrent infections and was considered in cases where conservative treatments alone were insufficient. Lung resection for lung abscess remains feasible in patients who do not respond to other treatments, and lobectomy or segmentectomy can be performed safely, with minimal morbidity and mortality [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our single-center, retrospective study, we examined 70 patients with lung abscess who underwent thoracoscopic surgical intervention, with the aim of identifying the predictors of outcome and mortality.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Eligibility criteria\u003c/h2\u003e \u003cp\u003eThe data of 628 patients who underwent video-assisted thoracic surgery (VATS) for empyema and lung abscess at our institution between January 2016 to August 2022 were reviewed retrospectively. The eligibility criteria for patient selection are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The inclusion criteria were patients: (1) aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years; (2) diagnosed with lung abscess and empyema using the International Classification of Diseases-10 diagnostic codes; and (3) who underwent surgery including decortication, unroofing, wedge resection, segmentectomy, lobectomy, bilobectomy, and pneumonectomy. Patients were excluded if they had: (1) simple empyema without lung abscess (chest CT did not depict lung abscess or obvious cavity formation and fluid-filled central necrosis was absent); (2) no evidence of inflammation, necrosis, infection, abscess, or empyema on the pathological reports; (3) chest wall abscess; and (4) no surgical intervention (e.g., bronchoscopy). The study was approved by the Institutional Review Board (IRB) of Far Eastern Memorial Hospital (IRB approval no. 111279-E), which waived the need for informed consent.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Preoperative assessment\u003c/h2\u003e \u003cp\u003eAll patients were treated by three attending thoracic surgeons at the Far Eastern Memorial Hospital, New Taipei City, Taiwan. Chest CT was performed for all patients to evaluate the extent of lung infection. We retrospectively reviewed the following clinical data: age, sex, comorbidity [Charlson Comorbidity Index (CCI)], smoking history, disease progression, etiology of lung abscess [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], and abscess location and size. In patients with comorbidity or disease progression, respiratory insufficiency referred to increased oxygen demand under initial treatment, respiratory failure was defined as ventilator use, and bilateral pneumonia implied that infection could not be controlled by medical treatment [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Operative technique\u003c/h2\u003e \u003cp\u003eAll patients underwent VATS in the operating room under general anesthesia and lung isolation with a double-lumen or single-lumen endotracheal tube with blocker intubation. Patients were placed in the decubitus position during the procedure. Some patients underwent only decortication, whereas others underwent additional procedures such as wedge resection and lobectomy to eradicate the infectious foci. No patient underwent pneumonectomy and bilobectomy. If patients underwent lobectomy using another procedure, they were categorized into the lobectomy group. We also confirmed lung re-expansion during operation by using two-lung ventilation and inserting one or two chest tubes via the ports.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Surgical outcomes\u003c/h2\u003e \u003cp\u003eWe obtained patients\u0026rsquo; basic data from their electronic medical records. After surgery, we analyzed their morbidity (Clavien-Dindo classification and the number of patients with grade\u0026thinsp;\u0026ge;\u0026thinsp;3B), length of intensive care unit (ICU) stay (days), and 30-day and 60-day mortality. We used univariate and multivariate Cox proportional modeling to analyze the outcomes to determine the predictive factors associated with 30-day and 60-day mortality.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Statistical analysis\u003c/h2\u003e \u003cp\u003eThe normality of numerical data was assessed using the Shapiro\u0026ndash;Wilk test. Normally distributed numerical data were expressed as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations, whereas non-normally distributed data were presented as medians (Q1, Q3). Categorical data were presented as frequencies and percentages. Statistical differences between groups were examined using the independent t-test/Mann\u0026ndash;Whitney U test or chi-squared/Fisher\u0026rsquo;s exact test, as appropriate, depending on the characteristics of the data. The 30-day mortality and 60-day mortality were estimated using Kaplan\u0026ndash;Meier analysis, and the differences between the lobectomy and non-lobectomy groups were analyzed using the log-rank test. The effect of lobectomy on mortality was analyzed using univariate and multivariate Cox proportional hazard regression. All statistical analyses were performed using IBM SPSS Statistics software version 22.0, with statistical significance between/among groups set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eWe divided 70 patients who underwent surgical intervention for lung abscesses into two groups based on the operative procedures. Thirty-two underwent lobectomy (lobectomy group) and the remaining 38 patients underwent surgery without lobectomy (non-lobectomy group). The patients\u0026rsquo; demographic features are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Fifty-six (80%) patients were men. The average age was 58.06 (\u0026plusmn;\u0026thinsp;15.9) years in the lobectomy group and 61.21 (\u0026plusmn;\u0026thinsp;11.3) years in the non-lobectomy group. Fourteen (43.8%) and 26 (68.4%) patients in the lobectomy and non-lobectomy groups reported a history of smoking, respectively (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The Mann\u0026ndash;Whitney U test did not reveal significant differences in the comorbidities and CCI between the two groups [lobectomy: 2.0 (1.0, 5.0); non-lobectomy: 3.5 (2.0, 5.0); \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.329]. We also divided lung abscess into primary and secondary based on etiology. Necrotizing pneumonia was the most common etiology of primary lung abscess, while tumor obstruction was the most common etiology of secondary lung abscess. Empyema was the most common progressive sign in both groups, whose frequency was significantly greater in the non-lobectomy group than in the lobectomy group (65.8% vs 34.4%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009). Respiratory insufficiency and bilateral pneumonia were the second and third most common signs of disease progression in both groups, respectively. Lung abscess occurred most commonly in the right lower lobe, and the location did not differ between the two groups. The size of the lung abscess did not differ significantly between the lobectomy (7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8 cm) and non-lobectomy groups (5.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3 cm).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic data and characteristics of patients who underwent operation for lung abscess.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLobectomy\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-lobectomy\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003e(min-max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.06\u0026thinsp;\u0026plusmn;\u0026thinsp;15.9\u003c/p\u003e \u003cp\u003e(29\u0026ndash;85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.21\u0026thinsp;\u0026plusmn;\u0026thinsp;11.3\u003c/p\u003e \u003cp\u003e(40\u0026ndash;89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.352\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (M:F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24:8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32:6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.337\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (68.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.324\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.775\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.544\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic obstructive pulmonary disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.402\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLung cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther malignancies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.972\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary artery disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.526\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebrovascular accident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.202\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLung disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.402\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic kidney disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharlson Comorbidity Index\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.0 (1.0, 5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.5 (2.0, 5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.329\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEtiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNecrotizing pneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (65.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (84.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAspiration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.496\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eimmunodeficiency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForeign body obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.205\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBronchiectasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCystic fibrosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBullous emphysema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubphrenic infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary infarct\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCongenital malformation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidity or progression of disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmpyema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (65.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory insufficiency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.324\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilateral pneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoptysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeptic shock\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.442\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAir leakage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.906\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight upper lobe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight middle lobe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight lower lobe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft upper lobe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLLL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSize\u003c/p\u003e \u003cp\u003e(min-max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003cp\u003e(2.5\u0026ndash;12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e \u003cp\u003e(2.7\u0026ndash;9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u0026dagger;The difference in the Charlson Comorbidity Index between the lobectomy and non-lobectomy groups was analyzed using the Mann\u0026ndash;Whitney test.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e near here]\u003c/p\u003e \u003cp\u003eThe 30-day mortality and 60-day mortality of the two groups are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The 30-day survival and 60-day survival were plotted as Kaplan\u0026ndash;Meier curves, which revealed that survival was longer in the lobectomy group (30-day mortality: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044 and 60-day mortality: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.048, respectively). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e describes the postoperative outcomes in this study. The rate of morbidity did not differ significantly between the two groups [16 (50%) vs 23 (60.5%); \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.377]. Pneumonia was the most common morbidity in both groups. Atrial fibrillation occurred only in the lobectomy group, but the difference with the non-lobectomy group lacked statistical significance. We used the Clavien-Dindo classification to grade the severity of surgical complications and found that the frequency of severe complications (Clavien-Dindo grade\u0026thinsp;\u0026ge;\u0026thinsp;3B) was greater in the non-lobectomy group than in the lobectomy group (25% vs 50%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.032). The length of ICU stay did not differ significantly between the two groups. We also compared the number of days on postoperative ventilation, and excluded (i) initial ventilation before surgery, (ii) transfer to the respiratory care ward for further care, and (iii) death after surgery. Extended use of ventilation was not required in the lobectomy group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePostoperative morbidity and outcomes.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLobectomy\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-lobectomy\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMortality (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMorbidity (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (60.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtelectasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.319\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePleural effusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.401\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProlonged air leakage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtrial fibrillation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBronchial injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFungemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVentricular tachycardia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavien-Dindo classification\u0026thinsp;\u0026ge;\u0026thinsp;3B (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of ICU stay (days) [median (Q1, Q3)]\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.0 (3.00, 13.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.0 (3.00, 16.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.741\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDays of postoperative ventilation\u0026dagger;\u0026Dagger;\u003c/p\u003e \u003cp\u003e[median (Q1, Q3)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003cp\u003e1.0 (1.0, 6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e \u003cp\u003e1.0 (1.0, 4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.913\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u0026dagger;The differences in the length of ICU stay and days on postoperative ventilation between the lobectomy and non-lobectomy groups were analyzed using the Mann\u0026ndash;Whitney test.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u0026Dagger;The data regarding days on postoperative ventilation exclude (i) initial ventilation before surgery, (ii) transfer to the respiratory care ward for further care, and (iii) death after surgery.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eICU: intensive care unit.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e near here]\u003c/p\u003e \u003cp\u003eIn our study, the Cox proportional hazard model (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) was used to analyze the outcomes in all patients. Multivariate analyses of 30- and 60-day mortality revealed that surgery with lobectomy was an independent factor that enhanced survival and that a higher CCI was a risk factor for higher mortality in patients with lung abscess.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCox proportional hazard model of 30-day and 60-day mortality for patients undergoing surgery for lung abscess\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30-day mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery with lobectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.293\u003c/p\u003e \u003cp\u003e(0.082\u0026ndash;1.053)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.255\u003c/p\u003e \u003cp\u003e(0.068\u0026ndash;0.959)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.024\u003c/p\u003e \u003cp\u003e(0.985\u0026ndash;1.064)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.985\u003c/p\u003e \u003cp\u003e(0.931\u0026ndash;1.043)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.603\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.897\u003c/p\u003e \u003cp\u003e(0.250\u0026ndash;3.215)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.867\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.319\u003c/p\u003e \u003cp\u003e(0.442\u0026ndash;3.936)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSize\u0026thinsp;\u0026ge;\u0026thinsp;5 cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.512\u003c/p\u003e \u003cp\u003e(0.177\u0026ndash;1.477)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.640\u003c/p\u003e \u003cp\u003e(0.202\u0026ndash;2.027)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.448\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharlson Comorbidity Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.268\u003c/p\u003e \u003cp\u003e(1.080\u0026ndash;1.488)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.286\u003c/p\u003e \u003cp\u003e(1.059\u0026ndash;1.561)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmpyema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.931\u003c/p\u003e \u003cp\u003e(0.326\u0026ndash;2.654)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.893\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.663\u003c/p\u003e \u003cp\u003e(0.224\u0026ndash;1.964)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.458\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60-day mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery with lobectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.372\u003c/p\u003e \u003cp\u003e(0.134\u0026ndash;1.035)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.319\u003c/p\u003e \u003cp\u003e(0.110\u0026ndash;0.921)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.027\u003c/p\u003e \u003cp\u003e(0.993\u0026ndash;1.062)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.992\u003c/p\u003e \u003cp\u003e(0.945\u0026ndash;1.041)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.734\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.905\u003c/p\u003e \u003cp\u003e(0.300\u0026ndash;2.729)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.860\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.632\u003c/p\u003e \u003cp\u003e(0.620\u0026ndash;4.295)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSize\u0026thinsp;\u0026ge;\u0026thinsp;5 cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.633\u003c/p\u003e \u003cp\u003e(0.249\u0026ndash;1.610)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.867\u003c/p\u003e \u003cp\u003e(0.306\u0026ndash;2.462)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.789\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharlson Comorbidity Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.294\u003c/p\u003e \u003cp\u003e(1.120\u0026ndash;1.496)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.317\u003c/p\u003e \u003cp\u003e(1.105\u0026ndash;1.571)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmpyema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.831\u003c/p\u003e \u003cp\u003e(0.337\u0026ndash;2.044)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.686\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.622\u003c/p\u003e \u003cp\u003e(0.245\u0026ndash;1.580)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e near here]\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn the current era, mortality due to lung abscess has declined substantially because of the advent of potent antibiotic therapy and the concept of drainage and intervention [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, despite this decline, the mortality rate remains unsatisfactory, ranging between 15% and 20% in recent years [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Lung abscess is often accompanied by other complications, and disease progression not only prolongs hospitalization but also encumbers treatment. Zhang et al. suggested the following indications for surgical intervention for lung abscess: treatment failure after intensive medical management, bronchopleural fistula, lung abscess\u0026thinsp;\u0026gt;\u0026thinsp;6 cm in diameter, and severe or life-threatening hemoptysis [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Diffuse destruction of the lung parenchyma may cause vascular insufficiency, limiting the delivery of antibiotics, and obstruction of the bronchus make hinder expectoration of the necrotic material [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Hence, complete eradication of the focus of infection may be a feasible choice in the event of failure of medical treatment for lung abscess.\u003c/p\u003e \u003cp\u003eLung abscess is highly concomitant with empyema. Cai et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] indicated that the risk of empyema was significantly higher for patients with pulmonary abscess measuring\u0026thinsp;\u0026ge;\u0026thinsp;5 cm than for patients with smaller abscesses. Surgical intervention is often indicated in symptomatic patients with empyema, for which previous studies have reported satisfactory outcomes [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, if the empyema is related to lung abscess, the ICU admission and mortality rates are higher, with a trend toward second surgical intervention [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In these cases, decortication or partial lung resection may afford insufficient infection control.\u003c/p\u003e \u003cp\u003eIn our study, age did not differ significantly between the two groups, while male preponderance was observed in the entire lung abscess cohort. We used the CCI to measure patients\u0026rsquo; comorbidities [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], and analyzed the etiology of lung abscess [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Previous studies indicated that pulmonary malignancy was a poor predictor for lung abscess, and excluded it from the prognostication process [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. However, in the acute phase, the primary aim is to keep patients alive before further treatment; thus, we included these patients to analyze the short-term outcomes. Empyema was the most common sign of disease progression in our study, and a previous study also indicated poor outcomes for concomitant lung abscess and empyema [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In the current study, we performed decortication to excise \u0026ldquo;the peel\u0026rdquo; to facilitate sufficient lung expansion and evaluated the possibility of lobectomy in patients with empyema. However, since empyema hindered the approach to the bronchus and vessels, the number of patients with empyema was higher in the non-lobectomy group. Hemoptysis and air leakage often necessitate surgical treatment. We tended to perform lobectomy in patients with massive hemoptysis to remove the affected lobe and potentially eliminate the source of bleeding (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02). In this study, the right lower lobe was the most common site of lung abscess, although the location of the lung abscess did not differ significantly between the two groups. We acquired chest CT in all patients before surgery and recorded the maximum diameter of the abscess cavity to determine its size. The lung abscess cavity size in the lobectomy group was larger than in the non-lobectomy group, albeit without statistical significance.\u003c/p\u003e \u003cp\u003eThe mortality rate for lung abscess accompanied by empyema exceeds 20% [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The mortality rate in our series was higher than that of previous studies, which could hypothetically be attributed to the larger abscess size and severe comorbidities in our patients. All patients underwent follow-up chest X-rays regularly after surgery. Persistent or progressive pneumonia was the most common post-surgical morbidity. We used the Clavien-Dindo classification to assess the surgical complications [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Although the morbidity rate did not differ significantly between the two groups in our study, the rate of Clavien-Dindo grade 3B was greater in the non-lobectomy group. Since we performed decortication or partial lung resection in the non-lobectomy group, the infectious source could not be eliminated completely. Damaged residual lung parenchyma could be a nidus for persistent or recurrent infections, necessitating further operation to control infection. No significant difference was noted with respect to the ICU stay and days on postoperative ventilation between the two groups. We analyzed the 30-day and 60-day mortality using Kaplan\u0026ndash;Meier analysis, which revealed that the lobectomy group had a significantly better survival rate. Previous studies have reported that ventilator use, concomitant empyema, septic shock, and preexisting comorbidity are among the risk factors for lung abscess [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Our study showed that the outcomes are affected by the underlying comorbidity and operation method. We hypothesized that lobectomy could eliminate the damaged lung parenchyma completely in cases that are refractory to antibiotic treatment and can also avert empyema development. The underlying comorbidity is an obvious risk factor for lung abscess, consistent with previous studies.\u003c/p\u003e \u003cp\u003eWe have summarized the details of past studies on surgery for lung abscess in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. All these studies were retrospective in design and described the indications for surgery and the surgical procedure. Empyema was the most common progressive symptom in two cohorts [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], and the second most common symptom in other two cohorts [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. According to those studies, empyema in patients with lung abscess often required surgical intervention, and lobectomy was the most common surgical strategy. The mortality rate ranged from 8.5\u0026ndash;15.4%, and the predictive factors included ventilator use, underlying disease, sepsis, and organ failure. In our study population, we recorded the size of the abscess, and our data illustrated that lobectomy could improve the outcome. However, the mortality rate was higher than that reported by previous studies.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDetails of past studies on surgery for lung abscess.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthors/years\u003c/p\u003e \u003cp\u003e(country)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudy type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIndications for surgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurgical procedures\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMorbidity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMortality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRisk factors\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReimel et al., 2006 (USA) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEmpyema, n\u0026thinsp;=\u0026thinsp;17\u003c/p\u003e \u003cp\u003eHemoptysis, n\u0026thinsp;=\u0026thinsp;5\u003c/p\u003e \u003cp\u003eAir leakage, n\u0026thinsp;=\u0026thinsp;7\u003c/p\u003e \u003cp\u003eSeptic shock, n\u0026thinsp;=\u0026thinsp;8\u003c/p\u003e \u003cp\u003eRespiratory distress, n\u0026thinsp;=\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePneumonectomy, n\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e \u003cp\u003eLobectomy, n\u0026thinsp;=\u0026thinsp;18\u003c/p\u003e \u003cp\u003eSegmentectomy, n\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003cp\u003eWedge resection, n\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e \u003cp\u003eDebridement, n\u0026thinsp;=\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWound infection, n\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003cp\u003eBronchial stump leak, n\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003cp\u003ePostoperative empyema, n\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e \u003cp\u003eCardiovascular instability, n\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (8.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eVentilator use (-)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKrishnadasan et al., 2000 (USA) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBronchopleural fistula, n\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003cp\u003eEmpyema, n\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003cp\u003eHemoptysis, n\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePneumonectomy, n\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003cp\u003eBilobectomy, n\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003cp\u003eLobectomy, n\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003cp\u003eWedge resection, n\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePostoperative empyema, n\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTsai et al., 2011 (Taiwan) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eProgressive respiratory distress, n\u0026thinsp;=\u0026thinsp;17\u003c/p\u003e \u003cp\u003eEmpyema, n\u0026thinsp;=\u0026thinsp;12\u003c/p\u003e \u003cp\u003eBronchopleural fistula, n\u0026thinsp;=\u0026thinsp;5\u003c/p\u003e \u003cp\u003eSeptic shock, n\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e \u003cp\u003eHemoptysis, n\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003cp\u003eBilateral pneumonia, n\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWedge resection, n\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003cp\u003eLobectomy, n\u0026thinsp;=\u0026thinsp;19\u003c/p\u003e \u003cp\u003eBilobectomy, n\u0026thinsp;=\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eProgressing pulmonary infection, n\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003cp\u003ePostoperative empyema, n\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUnderlying diseases (-)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchweigert et al., 2017 (Germany) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePulmonary sepsis, n\u0026thinsp;=\u0026thinsp;48\u003c/p\u003e \u003cp\u003eEmpyema, n\u0026thinsp;=\u0026thinsp;43\u003c/p\u003e \u003cp\u003ePersistent air leakage, n\u0026thinsp;=\u0026thinsp;25\u003c/p\u003e \u003cp\u003eAcute renal failure, n\u0026thinsp;=\u0026thinsp;12 Respiratory failure, n\u0026thinsp;=\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSegmentectomy, n\u0026thinsp;=\u0026thinsp;18 Lobectomy, n\u0026thinsp;=\u0026thinsp;58\u003c/p\u003e \u003cp\u003ePneumonectomy, n\u0026thinsp;=\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePulmonary sepsis (-)\u003c/p\u003e \u003cp\u003eSeptic organ failure (-)\u003c/p\u003e \u003cp\u003ePreexisting comorbidity (-)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOur study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSame as Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLobectomy, n\u0026thinsp;=\u0026thinsp;32\u003c/p\u003e \u003cp\u003eNon-lobectomy, n\u0026thinsp;=\u0026thinsp;38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSame as Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19 (27.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLobectomy (+)\u003c/p\u003e \u003cp\u003ePreexisting comorbidity (-)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e near here]\u003c/p\u003e \u003cp\u003eThe limitations of our study should be acknowledged. First, the study was retrospective in design. Second, lung function testing should have been performed before and after lobectomy to evaluate the change in lung volume. However, since all of our patients underwent emergency operations, data on lung function were insufficient for analysis. Third, we did not perform long-term follow-up after the surgical procedures. This was a single-center experience, and we endeavor to accrue more comprehensive data in the future. To date, surgical intervention for lung abscesses lacks unanimous consensus, and we hope that future studies can establish categorical and clear criteria.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eSurgical intervention for lung abscess refractory to pharmacotherapy remains controversial. We analyzed the predictive factors for mortality in patients who underwent surgical interventions and found that thoracoscopic lobectomy could significantly improve mortality compared to other interventions. Hence, thoracoscopic lobectomy may be an effective and feasible treatment option for lung abscess recalcitrant to medical treatment.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCharlson Comorbidity Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecomputed tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eintensive care unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVATS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003evideo-assisted thoracoscopic surgery\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthorship contribution statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePo-Keng Su: Conception and design of the study; Acquisition of data (laboratory or clinical); Data analysis and/or interpretation; Drafting of manuscript and/or critical revision; Approval of the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eShun-Mao Yang: Conception and design of the study; Data analysis and/or interpretation; Drafting of manuscript and/or critical revision; Approval of the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eCheng-Hung How: Conception and design of study; Acquisition of data (laboratory or clinical); Data analysis and/or interpretation; Drafting of manuscript and/or critical revision; Approval of the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eChao-Yu Liu: Acquisition of data (laboratory or clinical); Approval of the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eKa-I Leong: Acquisition of data (laboratory or clinical); Approval of the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eJei-Kuo Lin: Acquisition of data (laboratory or clinical); Approval of the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eSan-Fang Chou: Conception and design of study; Data analysis and/or interpretation.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCorresponding author\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Shun-Mao Yang, and Cheng-Hung How.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eEthics approval and consent to participate\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. This study was initiated by the Far Eastern Memorial Hospital. The study was approved by the Institutional Review Board (IRB) of Far Eastern Memorial Hospital (IRB approval no. 111279-E), which waived the need for informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsent for publication\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eAll authors in our study group agreed on the order of authorship and publication.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCompeting interests\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during this study will be available from the corresponding author on reasonable request after the publication of the main findings.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eReimel BA, Krishnadasen B, Cuschieri J, Klein MB, Gross J, Karmy-Jones R. Surgical management of acute necrotizing lung infections. Can Respir J. 2006;13:369\u0026ndash;73. https://doi.org/10.1155/2006/760390.\u003c/li\u003e\n \u003cli\u003eZhang JH, Yang SM, How CH, Ciou YF. Surgical management of lung abscess: from open drainage to pulmonary resection. J Vis Surg. 2018;4:224. https://doi.org/10.21037/jovs.2018.10.14.\u003c/li\u003e\n \u003cli\u003eKuhajda I, Zarogoulidis K, Tsirgogianni K, Tsavlis D, Kioumis I, Kosmidis C, et al. Lung abscess-etiology, diagnostic and treatment options. Ann Transl Med. 2015;3:183. https://doi.org/10.3978/j.issn.2305-5839.2015.07.08.\u003c/li\u003e\n \u003cli\u003eKrishnadasan B, Sherbin VL, Valli\u0026egrave;res E, Karmy-Jones R. Surgical management of lung gangrene. Can Respir J. 2000;7:401\u0026ndash;4. https://doi.org/10.1155/2000/174703.\u003c/li\u003e\n \u003cli\u003ePuligandla PS, Laberge JM. Respiratory infections: pneumonia, lung abscess, and empyema. Semin Pediatr Surg. 2008;17:42\u0026ndash;52. https://doi.org/10.1053/j.sempedsurg.2007.10.007.\u003c/li\u003e\n \u003cli\u003eSchweigert M, Dubecz A, Stadlhuber RJ, Stein HJ, Neuhof H. Modern history of surgical management of lung abscess: from Harold Neuhof to current concepts. Ann Thorac Surg. 2011;92:2293\u0026ndash;7. https://doi.org/10.1016/j.athoracsur.2011.09.035.\u003c/li\u003e\n \u003cli\u003eLord FT. Certain aspects of pulmonary abscess, from analysis of 227 cases. Boston Med Surg J. 1925;192:785\u0026ndash;8. https://doi.org/10.1056/NEJM192504231921701.\u003c/li\u003e\n \u003cli\u003eNeuhof H, Hurwitt E. Acute putrid abscess of the lung: VII. Relationship of the technic of the one-stage operation to results. Ann Surg. 1943;118:656\u0026ndash;64. https://doi.org/10.1097/00000658-194310000-00014.\u003c/li\u003e\n \u003cli\u003eShaw RR, Paulson DL. Pulmonary resection for chronic abscess of the lung. J Thorac Surg. 1948;17:514\u0026ndash;22. https://doi.org/10.1016/S0096-5588(20)31860-2.\u003c/li\u003e\n \u003cli\u003eMyers RT, Bradshaw HH. Conservative resection of chronic lung abscess. Ann Surg. 1950;131:985\u0026ndash;93. https://doi.org/10.1097/00000658-195006000-00019.\u003c/li\u003e\n \u003cli\u003eWaterman DH, Domm SE. Changing trends in the treatment of lung abscess. Dis Chest. 1954;25:40\u0026ndash;53. https://doi.org/10.1378/chest.25.1.40.\u003c/li\u003e\n \u003cli\u003eTsai YF, Tsai YT, Ku YH. Surgical treatment of 26 patients with necrotizing pneumonia. Eur Surg Res. 2011;47:13\u0026ndash;8. https://doi.org/10.1159/000327684.\u003c/li\u003e\n \u003cli\u003eMitchell JD, Yu JA, Bishop A, Weyant MJ, Pomerantz M. Thoracoscopic lobectomy and segmentectomy for infectious lung disease. Ann Thorac Surg. 2012;93:1033\u0026ndash;9; discussion 1039\u0026ndash;40. https://doi.org/10.1016/j.athoracsur.2012.01.012.\u003c/li\u003e\n \u003cli\u003eHirshberg B, Sklair-Levi M, Nir-Paz R, Ben-Sira L, Krivoruk V, Kramer MR. Factors predicting mortality of patients with lung abscess. Chest. 1999;115:746\u0026ndash;50. https://doi.org/10.1378/chest.115.3.746.\u003c/li\u003e\n \u003cli\u003ePohlson EC, McNamara JJ, Char C, Kurata L. Lung abscess: a changing pattern of the disease. Am J Surg. 1985;150:97\u0026ndash;101. https://doi.org/10.1016/0002-9610(85)90016-9.\u003c/li\u003e\n \u003cli\u003eWali SO. An update on the drainage of pyogenic lung abscesses. Ann Thorac Med. 2012;7:3\u0026ndash;7. https://doi.org/10.4103/1817-1737.91552.\u003c/li\u003e\n \u003cli\u003eCurry CA, Fishman EK, Buckley JA. Pulmonary gangrene: radiological and pathologic correlation. South Med J. 1998;91:957\u0026ndash;60. https://doi.org/10.1097/00007611-199810000-00012.\u003c/li\u003e\n \u003cli\u003ePhillips LG, Rao KV. Gangrene of the lung. J Thorac Cardiovasc Surg. 1989;97:114\u0026ndash;8. https://doi.org/10.1016/S0022-5223(19)35135-9.\u003c/li\u003e\n \u003cli\u003eHoffer FA, Bloom DA, Colin AA, Fishman SJ. Lung abscess versus necrotizing pneumonia: implications for interventional therapy. Pediatr Radiol. 1999;29:87\u0026ndash;91. https://doi.org/10.1007/s002470050547.\u003c/li\u003e\n \u003cli\u003eCai XD, Yang Y, Li J, Liao X, Qiu S, Xu J, et al. Logistic regression analysis of clinical and computed tomography features of pulmonary abscesses and risk factors for pulmonary abscess-related empyema. Clinics (Sao Paulo). 2019;74:e700. https://doi.org/10.6061/clinics/2019/e700.\u003c/li\u003e\n \u003cli\u003eRedden MD, Chin TY, van Driel ML. Surgical versus non-surgical management for pleural empyema. Cochrane Database Syst Rev. 2017;3:CD010651. https://doi.org/10.1002/14651858.CD010651.pub2.\u003c/li\u003e\n \u003cli\u003eWilshire CL, Jackson AS, Meggyesy AM, Buehler KE, Chang SC, Horslen LC, et al. Comparing initial surgery versus fibrinolytics for pleural space infections: a retrospective multicenter cohort study. Ann Am Thorac Soc. 2022;19:1827\u0026ndash;33. https://doi.org/10.1513/AnnalsATS.202108-964OC.\u003c/li\u003e\n \u003cli\u003eHuang HC, Chen HC, Fang HY, Lin YC, Wu CY, Cheng CY. Lung abscess predicts the surgical outcome in patients with pleural empyema. J Cardiothorac Surg. 2010;5:88. https://doi.org/10.1186/1749-8090-5-88.\u003c/li\u003e\n \u003cli\u003eCharlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373\u0026ndash;83. https://doi.org/10.1016/0021-9681(87)90171-8.\u003c/li\u003e\n \u003cli\u003eMwandumba HC, Beeching NJ. Pyogenic lung infections: factors for predicting clinical outcome of lung abscess and thoracic empyema. Curr Opin Pulm Med. 2000;6:234\u0026ndash;9. https://doi.org/10.1097/00063198-200005000-00012.\u003c/li\u003e\n \u003cli\u003eClavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187\u0026ndash;96. https://doi.org/10.1097/SLA.0b013e3181b13ca2.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eSchweigert M, Solymosi N, Dubecz A, John J, West D, Boenisch PL, et al. Predictors of outcome in modern surgery for lung abscess. Thorac Cardiovasc Surg. 2017;65:535\u0026ndash;41. https://doi.org/10.1055/s-0037-1598113.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Lobectomy, Lung abscess, Mortality, Pulmonary abscess drainage, Pulmonary resection","lastPublishedDoi":"10.21203/rs.3.rs-6426084/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6426084/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003cem\u003e: \u003c/em\u003eLung abscess is typically managed by performing abscess drainage. While pulmonary resection effectively controls infection, its role in eliminating necrotic tissue remains debatable due to risks such as bleeding, desaturation, systemic inflammation, persistent air leakage, and bronchopleural fistula. In this study, we evaluated the outcomes of pulmonary resection for lung abscess refractory to medical therapy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003cem\u003e: \u003c/em\u003eWe retrospectively analyzed 70 patients who underwent salvage thoracoscopic surgery for lung abscess, along with 60 days’ follow-up, at a tertiary referral hospital between January 2016 and August 2022. Thirty-two patients underwent lobectomy, while 38 did not. The patients’ demographics, comorbidities, disease progression, 30-day and 60-day mortality, and operative morbidity were compared between the lobectomy and non-lobectomy groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003cem\u003e: \u003c/em\u003eNecrotizing pneumonia was the leading cause of lung abscess (n=53, 75.7%), with empyema being the most common sign of disease progression (n=36, 51.4%). The lobectomy group had a lower mortality rate compared with the non-lobectomy group (15.6% vs 36.8%, \u003cem\u003ep\u003c/em\u003e=0.047). Multivariate analysis identified a higher Charlson Comorbidity Index (CCI) as a risk factor for 30-day mortality (HR=1.286, 95% CI=1.059–1.561; \u003cem\u003ep\u003c/em\u003e=0.011), while lobectomy mitigated the 30-day mortality risk (HR=0.255, 95% CI=0.068–0.959; \u003cem\u003ep\u003c/em\u003e=0.043). Similarly, a higher CCI augmented the 60-day mortality risk (HR=1.317, 95% CI=1.105–1.571; \u003cem\u003ep\u003c/em\u003e=0.002), whereas lobectomy lowered it (HR=0.319, 95% CI=0.110–0.921; \u003cem\u003ep\u003c/em\u003e=0.035).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003cem\u003e: \u003c/em\u003eLobectomy significantly improves the 30- and 60-day mortality outcomes compared to non-lobectomy surgery, making it a viable option for pharmacotherapy-refractory lung abscess.\u003c/p\u003e","manuscriptTitle":"Evaluating the Effectiveness of Thoracoscopic Intervention for Pulmonary Abscess: Is Lobectomy the Optimal Solution After Medical Therapy Fails?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-08 20:50:46","doi":"10.21203/rs.3.rs-6426084/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-14T18:03:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-12T12:43:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"275465694121888460813190831899355934417","date":"2025-05-05T08:01:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-03T18:13:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"302716724302768604049411663123999882479","date":"2025-05-02T05:33:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-30T19:15:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-30T19:09:28+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-21T17:13:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-18T16:54:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2025-04-18T16:53:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a874d41a-04a0-4833-b3af-34ea59c24978","owner":[],"postedDate":"May 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-20T16:10:00+00:00","versionOfRecord":{"articleIdentity":"rs-6426084","link":"https://doi.org/10.1186/s12893-025-03167-2","journal":{"identity":"bmc-surgery","isVorOnly":false,"title":"BMC Surgery"},"publishedOn":"2025-10-17 15:56:55","publishedOnDateReadable":"October 17th, 2025"},"versionCreatedAt":"2025-05-08 20:50:46","video":"","vorDoi":"10.1186/s12893-025-03167-2","vorDoiUrl":"https://doi.org/10.1186/s12893-025-03167-2","workflowStages":[]},"version":"v1","identity":"rs-6426084","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6426084","identity":"rs-6426084","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}