title: Retrospective study of clinical and lesion characteristics of patients undergoing surgical treatment for Pulmonary Tuberculosis in Georgia.
abstract: OBJECTIVE
  Our aim was to retrospectively compare clinical data and characteristics of removed lesions of the cohort of patients undergoing therapeutical surgery for their tuberculosis.
  
  
  METHODS
  Demographic and epidemiological details, clinical data, data on the surgery performed, macroscopic characteristics of the TB lesions removed, and outcome were recorded retrospectively from the 137 patients who underwent therapeutical surgery for their TB in Tbilisi, Georgia during 2014 and 2015.
  
  
  RESULTS
  Men represented 70% of the included patients, presented more comorbidities and underwent operation earlier in terms of days between diagnostic and surgery. Women underwent operation at younger ages, and in MDR/XDR-TB cases, showed higher percentages of sputum conversion at >2 months and of fresh necrosis in the surgical specimens, suggesting a worse evolution. Half of cases were MDR/XDR-TB cases. In spite of being considered microbiologically cured according to WHO, a non despricable percentage of cases showed viable bacilli in the surgical specimen. Even if no causality could be statistically demonstrated, differences could be encountered according to gender and drug susceptibility of the responsible strains.
  
  
  CONCLUSIONS
  According to our results, host factors such as gender, type of necrosis found in the lesions, size of lesions and presence of viable bacilli in the surgical specimen, should be included in future studies on therapeutical surgery of TB. As most of studies are done in MDR/XDR-TB, more data on DS-TB operated cases are needed. Our results also highlight that, in spite of achieving the microbiologically cured status, sterilization might not occur, and thus new biomarkers and new methods to evaluate the healing process of TB patients are urgently needed and radiological assays should be taken into account.
authors.affiliation: National Center for Tuberculosis and Lung Diseases (NCTLD), 50, Maruashvili Str. 0101 Tbilisi, Georgia.
authors.forename: Sergo
authors.initials: S
authors.lastname: Vashakidze
authors.affiliation: Experimental Tuberculosis Unit (UTE). Fundació Institut Germans Trias i Pujol (IGTP). Universitat Autònoma de Barcelona (UAB). Edifici Laboratoris de Recerca. Can Ruti Campus. Crtra. de Can Ruti, Camí de les Escoles, s/n. 08916, Badalona, Catalonia; Spain; CIBER Enfermedades Respiratorias, Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0. 28029, Madrid, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Despuig
authors.affiliation: National Center for Tuberculosis and Lung Diseases (NCTLD), 50, Maruashvili Str. 0101 Tbilisi, Georgia.
authors.forename: Shota
authors.initials: S
authors.lastname: Gogishvili
authors.affiliation: National Center for Tuberculosis and Lung Diseases (NCTLD), 50, Maruashvili Str. 0101 Tbilisi, Georgia.
authors.forename: Keti
authors.initials: K
authors.lastname: Nikolaishvili
authors.affiliation: National Center for Tuberculosis and Lung Diseases (NCTLD), 50, Maruashvili Str. 0101 Tbilisi, Georgia.
authors.forename: Natalia
authors.initials: N
authors.lastname: Shubladze
authors.affiliation: National Center for Tuberculosis and Lung Diseases (NCTLD), 50, Maruashvili Str. 0101 Tbilisi, Georgia.
authors.forename: Zaza
authors.initials: Z
authors.lastname: Avaliani
authors.affiliation: National Center for Tuberculosis and Lung Diseases (NCTLD), 50, Maruashvili Str. 0101 Tbilisi, Georgia.
authors.forename: Nestan
authors.initials: N
authors.lastname: Tukvadze
authors.affiliation: Agència de Salut Pública de Barcelona (ASPB), Plaça Lesseps, 1. 08023 Barcelona, Catalonia, Spain; CIBER Epidemiología y Salud Pública, Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0. 28029, Madrid, Spain.
authors.forename: Martí
authors.initials: M
authors.lastname: Casals
authors.affiliation: Agència de Salut Pública de Barcelona (ASPB), Plaça Lesseps, 1. 08023 Barcelona, Catalonia, Spain; CIBER Epidemiología y Salud Pública, Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0. 28029, Madrid, Spain.
authors.forename: Joan A
authors.initials: JA
authors.lastname: Caylà
authors.affiliation: Experimental Tuberculosis Unit (UTE). Fundació Institut Germans Trias i Pujol (IGTP). Universitat Autònoma de Barcelona (UAB). Edifici Laboratoris de Recerca. Can Ruti Campus. Crtra. de Can Ruti, Camí de les Escoles, s/n. 08916, Badalona, Catalonia; Spain; CIBER Enfermedades Respiratorias, Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0. 28029, Madrid, Spain.
authors.forename: Pere-Joan
authors.initials: PJ
authors.lastname: Cardona
authors.affiliation: Experimental Tuberculosis Unit (UTE). Fundació Institut Germans Trias i Pujol (IGTP). Universitat Autònoma de Barcelona (UAB). Edifici Laboratoris de Recerca. Can Ruti Campus. Crtra. de Can Ruti, Camí de les Escoles, s/n. 08916, Badalona, Catalonia; Spain; CIBER Enfermedades Respiratorias, Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0. 28029, Madrid, Spain. Electronic address: cvilaplana@gmail.com.
authors.forename: Cristina
authors.initials: C
authors.lastname: Vilaplana
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D015897:Comorbidity; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D005845:Georgia; D005846:Georgia (Republic); D006801:Humans; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*
chemical_list: D000995:Antitubercular Agents
keywords: DS-TB; Gender; MDR/XDR-TB; Necrosis; Surgery; Tuberculosis