Adjuvant resectional surgery improves cure rates in multidrug-resistant tuberculosis.
OBJECTIVE
Multidrug-resistant tuberculosis still continues to be a major health problem. Adjuvant surgical resection combined with antituberculous drug management is the most favorable treatment modality for patients with multidrug-resistant tuberculosis. In this article we report the results of surgical resections we performed during the years 1993 through 2005.


METHODS
We performed 81 lung resections in 79 patients with multidrug-resistant tuberculosis. All these patients had at least 2 months of medical therapy before resection. Bronchial reinforcement was performed in 4 of the 81 operations. We present here the surgical results of the 81 procedures. Because 5 of 79 patients were lost to follow-up, we provide the medical treatment results on 74 of the patients.


RESULTS
During this period, we performed 4 completion pneumonectomies, 39 pneumonectomies, 7 lobectomies with segmentectomy, 30 lobectomies, and 1 segmentectomy. Operative mortality was 2.5% (2/81). Bronchopleural fistula developed in 4 (4.9%) cases. Our overall cure rate was 94.5% (70/74). Relapse and treatment failure were 1.3% (1/74) and 1.3% (1/74), respectively. All but 5 patients are still under our follow-up.


CONCLUSIONS
Surgical resection of patients with multidrug-resistant tuberculosis combined with chemotherapy provides a favorable outcome. Our results will need to be validated more strongly by using randomized clinical trials that compare surgical resection plus chemotherapy with chemotherapy alone.
Kir
Altan
A
Division of Thoracic Surgery, Sureyyapasa Center for Chest Diseases and Thoracic Surgery, Maltepe, Istanbul, Turkey. altank@veezy.com
Inci
Ilhan
I
Torun
Tulay
T
Atasalihi
Ali
A
Tahaoglu
Kemal
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000601:surgery*