Adjuvant resectional surgery improves cure rates in multidrug-resistant tuberculosis

Kir, Altan; İnci, İlhan; Törün, Tülay; Atasalihi, Ali; Tahaoğlu, Kemal

doi:10.1016/j.jtcvs.2005.09.033

Cited by 50 publications

(24 citation statements)

References 16 publications

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“…Bronchoscopy was frequently used to rule out endobronchial tuberculosis, contralateral disease, and coexisting malignancy. 39,41,56,57,61 Pulmonary function testing with spirometry, in some cases followed by a ventilation/perfusion scan, was done to ensure adequate pulmonary reserve. An echocardiogram was occasionally performed to rule out pulmonary hypertension and congestive heart failure.…”

Section: Preoperative Workupmentioning

confidence: 99%

“…In patients with bilateral cavitary lesions, the largest lesion was usually resected or in a minority of cases a staged resection of bilateral lesions was done. 43,57 The most controversial aspect of surgical resection seemed to be whether bronchial stump reinforcement was needed to help prevent bronchopleural fistula (BPF) formation. Limited peribronchial tissue dissection was also utilized by most groups in an effort to promote healing of the bronchial stump.…”

Section: Surgical Proceduresmentioning

confidence: 99%

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Surgical treatment of drug-resistant tuberculosis

Kempker

Vashakidze

Solomonia

et al. 2012

The Lancet Infectious Diseases

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The global emergence and spread of multidrug resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) has led to the reexamination of surgical therapy as a possible adjunctive therapy for the treatment of drug-resistant TB. We present a case of a 26-year-old HIV-seronegative patient with pulmonary XDR-TB refractory to medical therapy. Surgical resection of the patient’s solitary cavitary lesion was performed as adjunctive treatment and a successful outcome with a combination of surgery and medical therapy was achieved. We review the history of surgical therapy for TB and the literature published on the role of surgical therapy in the treatment of MDR- and XDR-TB. A total of 26 case series and cohort studies were reviewed demonstrating surgical resection is beneficial in the treatment of drug-resistant TB; however, the results may not be applicable to all settings as all studies were observational, tended to select “healthier” TB patients, and all surgeries were performed at specialized thoracic surgery centers. Additional well-designed studies are needed to determine the efficacy of surgery in the treatment of drug-resistant TB.

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Section: Preoperative Workupmentioning

confidence: 99%

Section: Surgical Proceduresmentioning

confidence: 99%

Surgical treatment of drug-resistant tuberculosis

Kempker

Vashakidze

Solomonia

et al. 2012

The Lancet Infectious Diseases

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“…In experienced hands, the outcome of lung resection has been found to be rather rewarding. The cure rates could reach o90% with postsurgery chemotherapy (table 5) [209][210][211][212][213][214][215][216][217][218][219][220][221][222]. In resource-limited areas, the cure rates might be lower (63-75%), but lung resection still appears useful as adjunctive management for this formidable disease [218].…”

Section: Adjunctive Surgery For Pulmonary Tuberculosismentioning

confidence: 99%

Treatment of tuberculosis: update 2010

Yew¹,

Lange²,

Leung³

2010

Eur Respir J

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Currently, the standard short-course chemotherapy for tuberculosis comprises a 6-month regimen, with a four-drug intensive phase and a two-drug continuation phase. Alternative chemotherapy using more costly and toxic drugs, often for prolonged durations generally .18 months, is required for multidrug-resistant and extensively drug-resistant tuberculosis. Directly observed treatment, as part of a holistic care programme, is a cost-effective strategy to ensure high treatment success and curtail development of drug resistance in tuberculosis. New antituberculosis drugs are urgently needed to improve the present standard short-course and alternative chemotherapies, by shortening administration durations and increasing cure rates, through the greater potency of these agents. At the same time, the role of adjunctive surgery for drug-resistant tuberculosis has to be better defined. Immunotherapy might improve treatment outcomes of both drug-susceptible and -resistant tuberculosis, and warrants further exploration.

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“…Although Pomerantz and Shiraishi advocate the routine use of muscle flap reinforcement of the bronchial stump, 3,4) its use in patients with MDR-TB is debatable, because surgery without it had demonstrated adequate results. 6,11,13) On the other hand, many believe that maintenance of the peribronchial blood supply is critical. Minimal dissection and avoidance of electrical diathermy could prevent bronchopleural fistula.…”

Section: -7)mentioning

confidence: 99%

Surgery Offers High Cure Rates in Multidrug-resistant Tuberculosis

Yaldız

Gürsoy²,

Üçvet³

et al. 2011

Ann Thorac Cardiovasc Surg

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Purpose: Drug resistance has become a major problem in the treatment of tuberculosis, and pulmonary resection in combination with chemotherapy appears to be an effective measure for the treatment. The purpose of this study was to investigate the results of resection for multidrug-resistant pulmonary tuberculosis (MDR-TB). Patients and Methods: We retrospectively reviewed case files from January 2003 to December 2006 of 13 patients with MDR-TB underwent pulmonary resection. Results: Of 13 patients, 7 (53.9%) were sputum positive for mycobacterium tuberculosis preoperatively, though after surgery, they were sputum negative. Lobectomy was performed in 8 (61.5%) and pneumonectomy, in 5 (38.5%). In the lobectomy group, 2 patients had an additional superior segmentectomy and 1 had a middle lobectomy for other segmental or lobar lesions. Operative mortality was 7.6% (1/13). There were no late surgical deaths. In the early postoperative period, 3 patients had serious complications (postoperative bleeding, prolonged air leak, expansion deficit, bronchopleural fistula and empyema) that were resolved with surgery (morbidity 23.0%). The 12 patients who survived the operation received appropriate chemotherapy and were followed up for 24-37 months. None of the patients relapsed, and the overall cure rate was 92.3% (12/13). Conclusion: Even with high morbidity in the early post-operative period, surgery, in addition to medical therapy, offers higher cure rates than only medical therapy; however, meticulous preoperative evaluation of patients is needed.

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Adjuvant resectional surgery improves cure rates in multidrug-resistant tuberculosis

Abstract: Surgical resection of patients with multidrug-resistant tuberculosis combined with chemotherapy provides a favorable outcome. Our results will need to be validated more strongly by using randomized clinical trials that compare surgical resection plus chemotherapy with chemotherapy alone.

Cited by 50 publications

References 16 publications

Surgical treatment of drug-resistant tuberculosis

Surgical treatment of drug-resistant tuberculosis

Treatment of tuberculosis: update 2010

Surgery Offers High Cure Rates in Multidrug-resistant Tuberculosis

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