title: Pulmonary resection for multidrug-resistant tuberculosis: the Israeli experience (1998-2011).
abstract: BACKGROUND
  Multidrug-resistant tuberculosis (MDR-1B) presents a difficult therapeutic problem due to the failure of medical treatment. Pulmonary resection is an important adjunctive therapy for selected patients with MDR-TB.
  
  
  OBJECTIVE
  To assess the efficacy of pulmonary resection in the management of MDR-TB patients.
  
  
  METHODS
  We retrospectively reviewed the charts of MDR-TB patients referred for major pulmonary resections as part of a treatment strategy. The operations were performed in the departments of thoracic surgery at Assaf Harofeh and Wolfson Medical Centers. For the period under study, 13 years (1998-2011), we analyzed patients' medical history, bacteriological, medical and surgical data, morbidity, mortality, and short-term and long-term outcome.
  
  
  RESULTS
  We identified 19 pulmonary resections (8 pneumonectomies, 4 lobectomies, 1 segmentectomy, 6 wedge resections) from among 17 patients, mostly men, with a mean age of 32.9 years (range 18-61 years). Postoperative complications developed in six patients (35.3%) (broncho-pleural fistula in one, empyema in two, prolonged air leakin two, and acute renal failure in one). Only one patient (5.84%) died during the early postoperative period, three (17.6%) inthe late postoperative period, and one within 2 years after the resection. Of 12 survivors, 9 were cured, 2 are still under medical treatment, and 1 is lost from follow-up because of poor compliance.
  
  
  CONCLUSIONS
  Pulmonary resection for MDR-TB patients is an effective adjunctive treatment with acceptable morbidity and mortality.
authors: Department of Cardiothoracic Surgery, Wolfson Medical Center, Holon, Israel. drmishapapi@yahoo.com
authors: Michael
authors: M
authors: Papiashvili
authors: Ilan
authors: I
authors: Barmd
authors: Lior
authors: L
authors: Sasson
authors: Moshe
authors: M
authors: Lidji
authors: Klementy
authors: K
authors: Litman
authors: Atara
authors: A
authors: Hendler
authors: Vladimir
authors: V
authors: Polanski
authors: Leiv
authors: L
authors: Treizer
authors: Daniele
authors: D
authors: Bendayan
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents