title: Current surgical intervention for pulmonary tuberculosis.
abstract: BACKGROUND
  Surgery for pulmonary tuberculosis now plays a role in facing the emergence of complicated and multidrug resistant tuberculosis (MDR-TB), and it still remains a challenge for thoracic surgeons. We report on our 16 years of experience with lung resection for pulmonary tuberculosis.
  
  
  METHODS
  We retrospectively reviewed the surgical results of 35 patients (23 males and 12 females: mean age, 47.8 years) who underwent therapeutic surgical resection for pulmonary tuberculosis from 1988 to 2003.
  
  
  RESULTS
  Indications for surgery were MDR-TB in 26 patients, hemoptysis in 7, destroyed lung in 1, and drug allergy in 1. Thirty patients (85.7%) had fibrocavitary lesions seen radiologically, and 16 (61.5%) MDR-TB patients showed sputum-positive preoperatively. Operative procedures included 22 lobectomies, 7 pneumonectomies, 5 lobectomy plus segmentectomy procedures, and 1 segmentectomy. There was one operation-related death (2.9%) and 5 major postoperative complications (14.3%). Overall, 32 of 35 (91.4%) patients including 23 of 26 (88.5%) of the MDR-TB patients remained free of TB following surgery. Preoperative comorbidity, Aspergillus coinfection, operation time, transfusion, and male were the factors shown to be predictive of an unfavorable outcome.
  
  
  CONCLUSIONS
  Surgery remains a crucial adjunct to medical therapy for the treatment of MDR-TB and medical failure lesions. Treatment success was obtained in cases with MDR-TB with few and incomplete sensitive drugs, and the early morbidity and mortality were acceptable in the current series. Proper selection of the patients and early decision for surgical intervention can achieve a high success rate and the salvage of lung parenchyma in this difficult group of patients.
authors.affiliation: Department of Thoracic Surgery and Pulmonary Medicine, Toneyama National Hospital, Toyonaka City, Osaka, Japan. stakeda@toneyama.hosp.go.jp
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Takeda
authors.forename: Hajime
authors.initials: H
authors.lastname: Maeda
authors.forename: Masanobu
authors.initials: M
authors.lastname: Hayakawa
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Sawabata
authors.forename: Ryoji
authors.initials: R
authors.lastname: Maekura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D012189:Retrospective Studies; D014397:Tuberculosis, Pulmonary / Q000601:surgery*