Surgical management of lung abscess: from open drainage to pulmonary resection

Lung abscess is a type of infectious pulmonary disease, which occurs because of infection and destruction of the pulmonary parenchyma with central necrosis, eventually leading to cavity formation. The characteristic finding of chest roentgenogram is an air-fluid level in the cavitary lesion. In the era without antibiotics, putrid lung abscess was a crushing condition. In the early decades of the 20^th century, Neuhof proposed open drainage procedure for infection control of lung abscess, which effectively decreased the mortality rate of lung abscess from 75% to 2.5%. Around 1946, due to the advent of antibiotic, treatment of acute lung abscess with systemic antibiotics showed satisfied outcome. Thereafter, patients received medical treatment with systemic antibiotics rather than surgical management. Medical therapy with systemic antibiotics had become the principal treatment of lung abscess since then. Currently primary management of lung abscess mainly involves proper systemic antibiotics, intensive care, and, if indicated, percutaneous tube thoracostomy drainage. Surgical management for lung abscess became a more challenging task, since indication, timing, and the proper procedure for lung abscess are not well established. Undoubtedly, surgical intervention, including pulmonary resection or decortication procedure, tends to be restricted to those refractories to intensive medical treatment, complicated by life-threatening hemoptysis, pyopneumothorax, or pleural empyema. The primary goal of surgical management is adequate control of the septic focus.