title: Pulmonary resection in the treatment of 43 patients with well-localized, cavitary pulmonary multidrug-resistant tuberculosis in Shanghai.
abstract: OBJECTIVE
  Multidrug-resistant tuberculosis (MDR-TB), defined as tuberculosis resistant to at least isoniazid and rifampicin in vitro, poses a significant challenge to the control of TB worldwide. Despite global efforts to control tuberculosis, it remains the leading cause of death from an infectious agent. Although modern tuberculosis treatment relies on chemotherapy, surgery is accepted as adjuvant treatment for multidrug-resistant tuberculosis.
  
  
  METHODS
  In a retrospective cohort study, 43 MDR-TB patients (28 males and 15 females: mean age 45.3 years) who underwent pulmonary resection between January 1993 and December 2011 were reviewed. Every patient with well-localized, cavitary lesions showed sputum-positive preoperatively. Individually tailored treatment regimens were selected at a once-weekly staff conference following review of the patient's case history and drug susceptibility results. The variables that affected treatment outcomes were identified through multivariate regression analysis.
  
  
  RESULTS
  There was no surgical mortality. Forty (93.0%) patients demonstrated sputum conversion and/or remained negative after surgery. Each patient had completed treatment, and during a mean of 81 follow-up months (range 18-214 months), 1 patient relapsed. This patient was cured after another course of treatment. Operative procedures included 30 (69.8%) lobectomies, 2 (4.7%) bilobectomies, 8 (18.6%) pneumonectomies and 3 (6.98%) lobectomies plus segmentectomy. There were no operation-related deaths, and there were five major postoperative complications (11.6%). Overall, 40 of 43 (93.0%) MDR-TB patients remained free of TB following surgery. The duration of chemotherapy before surgery had correlation with postoperative outcome (P = 0.001).
  
  
  CONCLUSIONS
  The proper selection of the patients and early decision for surgical intervention can achieve a high success rate of pulmonary MDR-TB with well-localized pulmonary cavities.
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.
authors.forename: Boxiong
authors.initials: B
authors.lastname: Xie
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.forename: Wenxin
authors.initials: W
authors.lastname: He
authors.forename: Dong
authors.initials: D
authors.lastname: Xie
authors.forename: Gening
authors.initials: G
authors.lastname: Jiang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002681:China; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D018579:Patient Selection; D011013:Pneumonectomy / Q000009:adverse effects; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Multidrug resistant; Pulmonary cavity; Surgery; Tuberculosis