Lobectomy Or Pneumonectomy For Multidrug-Resistant Pulmonary Tuberculosis Can Be Performed With Acceptable Morbidity And Mortality: A Seven-year Review Of A Single Institution's Experience.

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Journal Title, Volume, Page: 
J Thorac Cardiovasc Surg. 2007 Jul;134(1):194-8.
Year of Publication: 
2007
Authors: 
Mohsen T
Zeid AA
Haj-Yahia S.
Preferred Abstract (Original): 

Combination chemotherapy is considered the first-line treatment for pulmonary tuberculosis. Despite related morbidity, the need for surgical resections coincides with the emergence of multidrug-resistant tuberculosis. This study presents a single-institution retrospective audit of the surgical management of 23 patients with multidrug-resistant tuberculosis.

METHODS:

We analyzed 23 consecutive patients undergoing anatomic pulmonary resections for human immunodeficiency virus-negative multidrug-resistant tuberculosis. Twenty were male (87%) and 3 were female (13%); their mean age was 24.4 years. We defined resistance in this cohort as failure to respond to combination chemotherapy, including isoniazid and rifampicin, with a mean duration of administration being 90 days. Fifteen of 23 (65.3%) patients, although sputum negative, were considered at risk for relapse owing to extensive parenchymal disease. Eight (34.7%) of 23 patients were sputum positive at the time of operation. We performed pneumonectomy on 11 (47.8%) and lobectomy on 12 (52%) patients. All had adjuvant chemotherapy for 18 to 24 months, with follow-ups ranging from 14 to 27 months.

RESULTS:

Stay in the intensive treatment unit was 2.9 days (range 1-17 days) and hospital stay, 8.6 days (range 5-45 days). Four (17%) patients had prolonged air leak, 3 (13%) required further treatment for empyema, with re-exploration for bleeding in 1 (4%). Hospital mortality was 4.3%. All patients attained sputum-negative status postoperatively (range 1-5 months). One (4%) patient had a relapse after 12 months.

CONCLUSION:

Surgery should be considered as an adjunct to medical therapy when eradicating multidrug-resistant tuberculosis in affected patients. Anatomic lung resections can be performed with acceptable morbidity and mortality. Early referral of such patients for surgical consideration is warranted.