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DOI: 10.1055/s-0029-1185458
© Georg Thieme Verlag KG Stuttgart · New York
The Value of Surgical Resection in Patients with Multidrug Resistant Tuberculosis
Publikationsverlauf
received July 26, 2008
Publikationsdatum:
20. Mai 2009 (online)
![](https://www.thieme-connect.de/media/thoracic/200904/lookinside/thumbnails/10.1055-s-0029-1185458-1.jpg)
Abstract
Background: Multidrug resistant tuberculosis (MDR‐TB) still continues to be a serious health problem throughout the world. Although main treatment of MDR‐TB is medical, surgical resection with adjuvant medical therapy may increase the chance of cure in selected patients. Methods: We performed surgical resections in 55 patients between 1997 and 2005; 36 were male and 19 were female with a median age of 34 years (range 13 to 66 years). Sputum was negative for 49 patients and positive for 6 patients in the preoperative period. Patients were treated according to a new therapy protocol for a mean of 3.7 months before the operation. Results: Lobectomy was performed in 37 patients, pneumonectomy in 17 patients and lobectomy + segmentectomy in 1 patient. One patient with positive sputum preoperatively died in the early postoperative period (mortality: 1.81 %). Various complications occurred in 16 (29.09 %) patients. Prolonged air leak was the most common complication (n = 8). Bronchopleural fistula (BPF) + empyema occurred in 2 (3.63 %) patients. In the postoperative period, sputum negativity was achieved in all patients except three cases throughout the 57 months of follow-up (cure rate 94.5 %). Patients received drug therapy for 24 months postoperatively. Conclusions: Surgical resection with adjuvant drug therapy increases the chance of cure in patients with localized disease if they have an adequate cardiopulmonary reserve, favorable nutritional status and are treated with a new therapy protocol for at least 3 months.
Key words
MDR‐TB - resection - cure chance
References
- 1 Pomerantz B J, Cleveland J C, Olson H K, Pomerantz M. Pulmonary resection for multi-drug resistant tuberculosis. J Thorac Cardiovasc Surg. 2001; 121 448-453
- 2 Mohsen T, Zeid A A, Haj-Yahia S. Lobectomy or pneumonectomy for multidrug-resistant tuberculosis can be performed with acceptable morbidity and mortality: a seven-year review of a single institution's experience. J Thorac Cardiovasc Surg. 2007; 134 194-198
- 3 Takeda S, Maeda H, Masanobu H, Sawabata N, Maekura R. Current surgical intervention for pulmonary tuberculosis. Ann Thorac Surg. 2005; 79 959-963
- 4 Shiraishi Y, Nakajima J, Katsuragi N, Kurai M, Takahashi N. Resectional surgery combined chemotherapy remains the treatment of choice for multidrug-resistant tuberculosis. J Thorac Cardiovasc Surg. 2004; 128 523-528
- 5 Sung S W, Kang C H, Kim Y T, Han S K, Shim Y S, Kim J H. Surgery increased chance of cure in multi-drug resistant pulmonary tuberculosis. Eur J Thorac Cardiothorac Surg. 1999; 16 187-193
- 6 World Health Organization .Anti-tuberculosis drug resistance in the world. Report no. 3. The WHO/IUATLD global project on anti-tuberculosis drug resistance surveillance 1999–2002. Geneva; World Health Organization 2004
- 7 Leuven M V, De Groot M, Shean K P, Von Oppel U O, Willcox P A. Pulmonary resection as an adjunct in the treatment of multiple drug-resisitant tuberculosis. Ann Thorac Surg. 1997; 63 1368-1373
- 8 Naidoo R. Active pulmonary tuberculosis: experiences with resection in 106 cases. Asian Cardiovasc Thorac Ann. 2007; 15 134-138
- 9 Kim Y T, Kim H K, Sung S W, Kim J H. Long-term outcomes and risk factor analysis pneumonectomy for active and sequela forms of pulmonary tuberculosis. Eur J Cardiothorac Surg. 2003; 23 833-839
- 10 Treasure R L, Seaworth B J. Current role of surgery in mycobacterium tuberculosis. Ann Thorac Surg. 1995; 59 1405-1409
- 11 Rizzi A, Rocco G, Robustellini M, Rossi G, Pona C D, Massera F. Results of surgical treatment of tuberculosis. Experience in 206 patients undergoing operation. Ann Thorac Surg. 1995; 59 896-900
Dr. Alpay Orki Orki, Specialist
Heybeliada Chest Diseases and Chest Surgery Center
Thoracic Surgery
Camlica Plamiye Sitesi 11-3
Yavuzturk Uskudar
Istanbul 34692
Turkey
Telefon: + 90 53 23 82 35 73
Fax: + 90 21 63 70 97 19
eMail: alpayorki@yahoo.com