Which of the following treatments would be appropriate therapy for symptoms that persist on medical therapy and bronchiectasis involving, in order of decreasing severity, the left lower lobe, the right middle lobe, and the left upper lobe?

C. Left lower lobectomy.

DISCUSSION: Pneumonectomy is seldom indicated today for bronchiectasis. Anatomic resection of involved segments with either segmentectomy or lobectomy is preferred to nonanatomic wedge resection. Bilateral pulmonary resections should generally be done as staged procedures, the most symptomatic side being resected first. Then, the contralateral side is resected only if symptoms persist during a prolonged course of medical therapy.