Surgical treatment for multidrug-resistant and extensive drug-resistant tuberculosis.
BACKGROUND
Multidrug-resistant (MDR) and extensive drug-resistant (XDR) tuberculosis (TB) are still significant health problems. Surgical resection is an adjunctive intervention for patients with MDR or XDR TB. This study presents the short-term and long-term results of surgical treatment for MDR or XDR TB at a single center.


METHODS
Between May 1996 and March 2008, surgical resection was performed on 72 patients with MDR or XDR TB at a single institution. Among these patients, 26 patients (36%) had XDR TB. All patients received multidrug regimens preoperatively and postoperatively. The preoperative sputum smears and cultures were positive in 52 patients (72%) and 58 patients (81%), respectively. The indications for surgery included failure of medical treatment in 51 patients (71%), localized disease or persistent cavity with high probability of relapse in 17 patients (24%), and combined complications such as hemoptysis in 4 patients (5%).


RESULTS
Thirty-eight patients (53%) had a lobectomy with or without segmentectomy or wedge resection, 23 patients (32%) had pneumonectomies, 10 patients received segmentectomies, and 1 patient had multiple wedge resections. There was one postoperative death that was attributable to a thoracic empyema. Eight (11%) postoperative complications occurred, including empyema in 5 patients, bleeding in 2 patients, and postpneumonectomy syndrome in 1 patient. A favorable outcome was achieved in 65 patients (90%) after surgical resection. The favorable outcome rates did not differ significantly between patients with MDR TB and those with XDR TB (93% versus 85%; p = 0.244).


CONCLUSIONS
Early pulmonary resection combined with chemotherapy had high cure rates with acceptable complications and preservation of the lung parenchyma in MDR TB and XDR TB.
Kang
Min-Woong
MW
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Kim
Hong Kwan
HK
Choi
Yong Soo
YS
Kim
Kwhanmien
K
Shim
Young Mog
YM
Koh
Won-Jung
WJ
Kim
Jhingook
J
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003131:Combined Modality Therapy; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007723:Korea; D008297:Male; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*
D000995:Antitubercular Agents