title: Lobectomy or pneumonectomy for multidrug-resistant pulmonary tuberculosis can be performed with acceptable morbidity and mortality: a seven-year review of a single institution's experience.
abstract: OBJECTIVE
  Combination chemotherapy is considered the first-line treatment for pulmonary tuberculosis. Despite related morbidity, the need for surgical resections coincides with the emergence of multidrug-resistant tuberculosis. This study presents a single-institution retrospective audit of the surgical management of 23 patients with multidrug-resistant tuberculosis.
  
  
  METHODS
  We analyzed 23 consecutive patients undergoing anatomic pulmonary resections for human immunodeficiency virus-negative multidrug-resistant tuberculosis. Twenty were male (87%) and 3 were female (13%); their mean age was 24.4 years. We defined resistance in this cohort as failure to respond to combination chemotherapy, including isoniazid and rifampicin, with a mean duration of administration being 90 days. Fifteen of 23 (65.3%) patients, although sputum negative, were considered at risk for relapse owing to extensive parenchymal disease. Eight (34.7%) of 23 patients were sputum positive at the time of operation. We performed pneumonectomy on 11 (47.8%) and lobectomy on 12 (52%) patients. All had adjuvant chemotherapy for 18 to 24 months, with follow-ups ranging from 14 to 27 months.
  
  
  RESULTS
  Stay in the intensive treatment unit was 2.9 days (range 1-17 days) and hospital stay, 8.6 days (range 5-45 days). Four (17%) patients had prolonged air leak, 3 (13%) required further treatment for empyema, with re-exploration for bleeding in 1 (4%). Hospital mortality was 4.3%. All patients attained sputum-negative status postoperatively (range 1-5 months). One (4%) patient had a relapse after 12 months.
  
  
  CONCLUSIONS
  Surgery should be considered as an adjunct to medical therapy when eradicating multidrug-resistant tuberculosis in affected patients. Anatomic lung resections can be performed with acceptable morbidity and mortality. Early referral of such patients for surgical consideration is warranted.
authors.affiliation: Department of Cardiothoracic Surgery, Kasr El Aini Hospital, Cairo University, Cairo, Egypt.
authors.forename: Tarek
authors.initials: T
authors.lastname: Mohsen
authors.forename: Amany Abou
authors.initials: AA
authors.lastname: Zeid
authors.forename: Saleem
authors.initials: S
authors.lastname: Haj-Yahia
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004653:Empyema / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000401:mortality* / Q000601:surgery*; D014397:Tuberculosis, Pulmonary / Q000401:mortality* / Q000601:surgery*