title: The Role of Video-Assisted Thoracoscopic Therapeutic Resection for Medically Failed Pulmonary Tuberculosis.
abstract: There are few reports regarding video-assisted thoracoscopic therapeutic resection for medically failed pulmonary tuberculosis (TB). We reviewed our surgical results of video-assisted thoracoscopic surgery (VATS) therapeutic resection for pulmonary TB with medical failure, and its correlation with image characteristics on chest computed tomography (CT) scan.Between January 2007 and December 2012, among the 203 patients who had surgery for TB, the medical records of 89 patients undergoing therapeutic resection for medically failed pulmonary TB were reviewed. Clinical information and the image characteristics of CT scan were investigated and analyzed.Forty-six of the 89 patients undergoing successful VATS therapeutic resection had significantly lower grading in pleural thickening (P < 0.001), peribronchial lymph node calcification (P < 0.001), tuberculoma (P = 0.015), cavity (P = 0.006), and aspergilloma (P = 0.038); they had less operative blood loss (171.0 ± 218.7 vs 542.8 ± 622.8 mL; P < 0.001) and shorter hospital stay (5.2 ± 2.2 vs 15.6 ± 15.6 days; P < 0.001). They also had a lower percentage of anatomic resection (73.9% vs 93.0%; P = 0.016), a higher percentage of sublobar resection (56.5% vs 32.6%; P = 0.023), and a lower disease relapse rate (4.3% vs 23.3%; P = 0.009). Eighteen of the 38 patients with multi-drug resistant pulmonary tuberculosis (MDRTB) who successfully underwent VATS had significantly lower grading in pleural thickening (P = 0.001), peribronchial lymph node calcification (P = 0.019), and cavity (P = 0.017). They were preoperatively medicated for a shorter period of time (221.6 ± 90.8 vs 596.1 ± 432.5 days; P = 0.001), and had more sublobar resection (44.4% vs 10%), less blood loss (165.3 ± 148.3 vs 468.0 ± 439.9 mL; P = 0.009), and shorter hospital stay (5.4 ± 2.6 vs 11.8 ± 6.9 days; P = 0.001).Without multiple cavities, peribronchial lymph node calcification, and extensive pleural thickening, VATS therapeutic resection could be safely performed in selected patients with medically failed pulmonary TB as an effective adjunct with satisfactory results.
authors.affiliation: From the Department of Surgery, Division of Thoracic Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan (Y-LT, Y-YC, Y-TY); Department of Surgery, Division of Thoracic Surgery, Chia-Yi Christian Hospital, Chia-Yi (J-MC); Graduate Institute of Medical Sciences, Collage of Health Science, Chang Jung Christian University, Tainan (J-MC); Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University (Y-SL, LC); Department of Surgery, Division of Thoracic Surgery, Tainan Municipal Hospital (M-HW); Center for Infection Control, National Cheng Kung University Hospital (C-LL); and Institute of Clinical Medicine, College of Medical College (J-MC, Y-TY), National Cheng Kung University, Tainan, Taiwan.
authors.forename: Yau-Lin
authors.initials: YL
authors.lastname: Tseng
authors.forename: Jia-Ming
authors.initials: JM
authors.lastname: Chang
authors.forename: Yi-Sheng
authors.initials: YS
authors.lastname: Liu
authors.forename: Lili
authors.initials: L
authors.lastname: Cheng
authors.forename: Ying-Yuan
authors.initials: YY
authors.lastname: Chen
authors.forename: Ming-Ho
authors.initials: MH
authors.lastname: Wu
authors.forename: Chung-Lan
authors.initials: CL
authors.lastname: Lu
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Yen
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D002114:Calcinosis / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010994:Pleura / Q000000981:diagnostic imaging / Q000473:pathology; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D013624:Taiwan / Q000453:epidemiology; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D014396:Tuberculosis, Pleural / Q000175:diagnosis / Q000209:etiology; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery
chemical_list: D000995:Antitubercular Agents