Resectional surgery combined with chemotherapy remains the treatment of choice for multidrug-resistant tuberculosis

Shiraishi, Yuji; Nakajima, Yutsuki; Katsuragi, Naoya; Kurai, Makoto; Takahashi, Nobumasa

doi:10.1016/j.jtcvs.2004.06.012

Cited by 63 publications

(37 citation statements)

References 17 publications

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“…Significant morbidity of the surgical treatment is reported to be about 20%-25%. 4,10,11) Here, we report a 23% morbidity and 92.3% cure rate, which are comparable to other studies, bearing out the efficacy of surgery in the management of MDR-TB. In this study, 1 patient with dense adhesions in the chest wall and hilus underwent re thoracotomy for the bleeding.…”

Section: -7)supporting

confidence: 88%

“…This patient was treated by open drainage (pleurocutaneous flap). 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.…”

Section: -7)mentioning

confidence: 99%

“…In these cases, resection of cavitary lesions, or destructive of a lobe or lung, would lower the bacilli count and possibly improve the efficiency of medical treatment. 3,4) Even though the fluoroquinolone group of antibiotics may be effective in the treatment, the disease cannot be eliminated entirely.…”

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confidence: 99%

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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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Section: -7)supporting

confidence: 88%

Section: -7)mentioning

confidence: 99%

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Surgery Offers High Cure Rates in Multidrug-resistant Tuberculosis

Yaldız

Gürsoy²,

Üçvet³

et al. 2011

Ann Thorac Cardiovasc Surg

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“…Van Leuven et al [23] reported a >80% cured rate of surgical treatment in MDR-TB. Shiraishi et al [24] reported a similar rate. The major point in surgery is to resect the active TB lesions as effectively as possible to achieve a relatively effective treatment.…”

Section: Discussionmentioning

confidence: 75%

Surgical treatment efficacy in 172 cases of tuberculosis-destroyed lungs

Bai

Hong

Gong

et al. 2011

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES: Compared to the use of anti-TB drugs for the treatment of tuberculosis (TB), surgery is destructive and is associated with higher risk. Whether surgery is needed for the treatment of TB-destroyed lungs (for short: destroyed lungs) is still controversial and unresolved in the clinic. METHODS:Retrospective analysis of treatment efficacy was performed on 172 cases of destroyed lungs (176 surgeries) in the Thoracic Surgery Department of our hospital from April 1992 to June 2010. RESULTS:A total of 83 male and 89 female patients was analyzed. The youngest patient was 7 years old, and the oldest was 72 years old, with a mean age of 38.4 years. A total of 120 cases had a preoperative cough, 31 cases had fever, and 42 cases had hemoptysis. A total of 49 cases was positive for Mycobacterium tuberculosis by sputum test before surgery, yielding a positive TB rate of 28.5% (49/172). A total of 116 patients had a destroyed left lung and 56 cases had a destroyed right lung. In all, 110 cases underwent total pneumonectomy, 37 pleuropneumonectomy, one lobectomy, 10 residual lobectomy, two total pneumonectomy and tracheoplasty, 11 cases bronchopleural fistula (BPF) repair and other surgeries, and one case underwent thoracoplasty. A total of four patients underwent thoracoplasty 30 days after surgery due to a thoracic cavity infection or empyema. The overall perioperative mortality rate was 2.9% (5/172). The surgical complication rate was 18.6% (32/172). The sputum negative conversion rate was 87.8% (43/49), and the clinical cure rate was 91.9% (158/172). CONCLUSIONS:Our findings suggested that surgical treatment efficacy in destroyed lungs was satisfactory with strict surgical indications, standard preoperative anti-TB treatment, adequate preoperative preparation, and careful intraoperative operations.

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“…Caminero [13] considers surgery when the patient meets the following conditions: a) localized lesions; b) adequate pulmonary functions; and c) lack of sufficiently available drugs to design a potent regimen. Lallo et al [14], Furak et al [23], Freixnet et al [24], Shirashi et al [25] and Takeda et al [26] have a broader range of indications for pulmonary surgery in this setting, including high profile resistance, multiple previous relapses, persistent sputum positivity despite four-six months of therapy, high risk of recurrence based on the presence of destroyed lung tissue and cavities, hemoptysis, and drug allergy.…”

Section: Figure 1 Radiological Findings Of Mdr-tb Patients See Detamentioning

confidence: 99%

Multidrug-resistant tuberculosis: case reports study in a central state of Brazil

Araújo-Filho¹,

Vasconcelos-Jr²,

Sousa³

et al. 2008

Braz J Infect Dis

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Multidrug-resistant tuberculosis (MDR-TB) is an emerging and worrisome health problem that threatens tuberculosis (TB) control worldwide. The clinical management of MDR-TB is a complex issue associated with the use of multiple drugs for a long period, usually accompanied by side effects and high costs. The objective of this work was to relate cases of MDR-TB occurring in Goiás, a central state of Brazil. We related five cases of MDR-TB, three women and two men. All were pulmonary cases. Three were in their second treatment and two in their first treatment. Surgical pulmonary resection was performed in one case. One death occurred. Lack of adherence, gastric intolerance to anti-TB drugs and poor clinical management were the main aspects related to the emergent resistance. A revision of the main clinical aspects of this disease was performed.

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Resectional surgery combined with chemotherapy remains the treatment of choice for multidrug-resistant tuberculosis

Cited by 63 publications

References 17 publications

Surgery Offers High Cure Rates in Multidrug-resistant Tuberculosis

Surgery Offers High Cure Rates in Multidrug-resistant Tuberculosis

Surgical treatment efficacy in 172 cases of tuberculosis-destroyed lungs

Multidrug-resistant tuberculosis: case reports study in a central state of Brazil

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