title: [Adjuvant surgical resection for multidrug-resistant tuberculosis: A review].
abstract: BACKGROUND
  The frequency of multi and extensively drug resistant pulmonary tuberculosis (MDR/XDR-TB) is increasing worldwide, with major issues related to treatment modalities and outcome. In this setting, the exact benefits associated with surgical resection are still unknown.
  
  
  METHODS
  We performed a literature review to determine the indications, morbidity, mortality and bacteriological success associated with the surgical management of MDR/XDR-TB patients.
  
  
  RESULTS
  Altogether, 177 publications dealing with surgical resection and MDR/XDR-TB have been analyzed, including 35 surgical series and 24 cohort studies summarized in one meta-analysis. The surgical series reported success rates from 47% to 100%, complication rates from 0 to 29%, and mortality rates from 0 to 8%. The published meta-analysis reported a statistically significant association between surgical resection and treatment success (OR 2.24, IC95% 1.68-2.97). However, all these studies were associated with selection bias. International consensual guidelines included a multidisciplinary assessment in a reference centre, a personalized and prolonged antibiotic treatment and a medico-surgical discussion on a case-to-case basis.
  
  
  CONCLUSIONS
  These guidelines are now applied for the management of patients with MDR/XDR-TB in our centre. Further studies are required to avoid further increase in the burden of MDR/XDR-TB and to establish the optimal timing of medical and surgical treatments.
authors.affiliation: Service de chirurgie thoracique et transplantation pulmonaire, université René-Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Mordant
authors.affiliation: Service de maladies infectieuses, université Pierre-et-Marie-Curie, groupe hospitalier Pitié-Salpêtrière, Charles-Foix, 75013 Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Henry
authors.affiliation: Service de pneumologie et réanimation médicale, université Pierre-et-Marie-Curie, groupe hospitalier Pitié-Salpêtrière, Charles-Foix, 75013 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Morel
authors.affiliation: Centre national de référence des mycobactéries et de la résistance des mycobactéries aux antituberculeux, laboratoire de bactériologie-hygiène hospitalière, université Pierre-et-Marie-Curie, groupe hospitalier Pitié-Salpêtrière, Charles-Foix, 75013 Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Robert
authors.affiliation: Centre national de référence des mycobactéries et de la résistance des mycobactéries aux antituberculeux, laboratoire de bactériologie-hygiène hospitalière, université Pierre-et-Marie-Curie, groupe hospitalier Pitié-Salpêtrière, Charles-Foix, 75013 Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Veziris
authors.affiliation: Pôle médecine et maladies infectieuses, centre hospitalier de Bligny, 91640 Briis-sous-Forges, France.
authors.forename: D
authors.initials: D
authors.lastname: Le Dû
authors.affiliation: Pôle médecine et maladies infectieuses, centre hospitalier de Bligny, 91640 Briis-sous-Forges, France.
authors.forename: M
authors.initials: M
authors.lastname: Frechet-Jachym
authors.affiliation: Service de pneumologie et réanimation médicale, université Pierre-et-Marie-Curie, groupe hospitalier Pitié-Salpêtrière, Charles-Foix, 75013 Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Similowski
authors.affiliation: Service de maladies infectieuses, université Pierre-et-Marie-Curie, groupe hospitalier Pitié-Salpêtrière, Charles-Foix, 75013 Paris, France.
authors.forename: É
authors.initials: É
authors.lastname: Caumes
authors.affiliation: Service de chirurgie thoracique et transplantation pulmonaire, université René-Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Riquet
authors.affiliation: Service de chirurgie thoracique et transplantation pulmonaire, université René-Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France. Electronic address: francoise.lepimpec-barthes@egp.aphp.fr.
authors.forename: F
authors.initials: F
authors.lastname: Le Pimpec-Barthes
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D009169:Mycobacterium tuberculosis; D019616:Thoracic Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*
chemical_list: D000995:Antitubercular Agents
keywords: Chirurgie thoracique; Extensively drug resistant tuberculosis; MDR-TB; Multidrug-resistant tuberculosis; Thoracic surgery; Tuberculose multirésistante; Tuberculose ultrarésistante; XDR-TB