Role of surgery in multi-drug-resistant tuberculosis: results of 27 cases

Kir, Altan

doi:10.1016/s1010-7940(97)00230-3

Cited by 31 publications

(20 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The most important clinical treatment for a destroyed lung before, during, and after surgery was the prevention of empyema and BPF [9]. For patients with Mycobacterium tuberculosis-positive sputum before surgery, a drug-resistant test of TB was needed for choosing effective anti-TB drugs after surgery [10,11]. During preoperative preparation, Gass and Olsen suggested [12] that a postoperative FEV 1.0 of patients scheduled for pneumonectomy should be greater than 0.8 l; when FEV 1.0 was <2 l and MVV% was <50%, the surgical risk of pneumonectomy increased significantly.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment efficacy in 172 cases of tuberculosis-destroyed lungs

Bai

Hong

Gong

et al. 2011

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Surgical treatment efficacy in 172 cases of tuberculosis-destroyed lungs

Bai

Hong

Gong

et al. 2011

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…16 Several cohorts of patients with MDR-TB undergoing surgery have been reported in the literature. [17][18][19][20][21][22] In general, the studies show excellent microbiological outcomes with low complications rates, but most of the cohorts are small and all are from relatively wealthy countries. To date, there has been no report on the use of surgical treatment for the management of MDR-TB under programme conditions in resource-poor settings.…”

mentioning

confidence: 99%

Surgery for patients with drug-resistant tuberculosis: report of 121 cases receiving community-based treatment in Lima, Peru

Somocurcio¹,

Sotomayor²,

Shin

et al. 2007

Thorax

View full text Add to dashboard Cite

Background: While most patients with tuberculosis (TB) can be successfully treated using short-course medical chemotherapy, thoracic surgery is an important adjunctive strategy for many patients with drug-resistant disease. The need for physical, technical and financial resources presents a potential challenge to implementing surgery as a component of treatment for multidrug-resistant TB (MDR-TB) in resource-poor settings. However, a cohort of patients with severe MDR-TB in Lima, Peru underwent surgery as part of their treatment. Methods: 121 patients underwent pulmonary surgery for drug-resistant tuberculosis between May 1999 and January 2004. Surgery was performed by a team of thoracic surgeons under the Ministry of Health. Patient demographic data, clinical characteristics, surgical procedures and surgical outcomes were studied. Results: Most of the patients had failed multiple TB regimens and were resistant to a median of seven drugs. The median time of follow-up after surgery was 33 months. 79.3% of patients were culture-positive before surgery, and sustained culture-negative status among survivors was achieved in 74.8% of patients. 63% of those followed up for at least 6 months after surgery were either cured or probably cured. Postoperative complications, observed in 22.6% of patients, were associated with preoperative haemoptysis, vital capacity ,50% and low forced expiratory volume in 1 s. Conclusions: This is one of the largest cohorts with MDR-TB to be treated with surgery, and the first from a resource-poor country. Although surgery is not often considered an option for patients in resource-poor settings, the findings of this study support the argument that adjunctive surgery should be considered an integral component of MDR-TB treatment programmes, even in poor countries such as Peru.

show abstract

“…En nuestro estudio, los pacientes recibieron tratamiento prequirúrgico por un tiempo promedio de 1,5 meses, tiempo similar al recomendado en otros estudios (2 meses) (23). La cirugía se debe llevar a cabo tempranamente durante la terapia farmacológica con el fin de evitar mayor deterioro y preservar la mayor cantidad posible de parénquima pulmonar (24,25).…”

Section: Discussionunclassified

Cirugía en tuberculosis pulmonar multirresistente.

Tobón¹,

Paniagua²,

Henao³

et al. 2004

biomedica

View full text Add to dashboard Cite

La aparición de Mycobacterium tuberculosis multirresistente constituye un serio problema para el control de la tuberculosis, por lo que se ha considerado que la resección quirúrgica del tejido pulmonar afectado, junto con el tratamiento médico adecuado, podría proporcionar la curación en algunos pacientes con tuberculosis pulmonar multiresistente. En este estudio de tipo descriptivo, retrospectivo, se evaluaron los resultados clínicos y bacteriológicos de la resección quirúrgica en un grupo seleccionado de pacientes con tuberculosis pulmonar multirresistente. Se revisaron las historias clínicas del Hospital La María de Medellín de 1990 a 2000, y se encontró que se habían sometido a cirugía 73 pacientes con diagnóstico de tuberculosis durante este periodo, 28 de los cuales tenían como indicación quirúrgica tuberculosis multirresistente (resistencia a isoniacida y rifampicina), 21 de los cuales habían recibido tratamiento prequirúrgico. En 14 (50%) se había practicado lobectomía superior y en 10 (36,7%), neumonectomía. Todos recibieron tratamiento posquirúrgico por un periodo promedio de 12,5 meses. En 88,9% (25/27) de los casos, la baciloscopia fue negativa después de 6 semanas de la cirugía y hasta finalizar el tratamiento antituberculoso; 6 pacientes presentaron nuevamente baciloscopia positiva, aunque 4 tuvieron baciloscopia negativa después de un nuevo esquema de tratamiento. Los pacientes, de acuerdo con las normas del ministerio, fueron seguidos con baciloscopia mensual y no con cultivo como es lo indicado en los casos de multirresistencia. La cirugía junto con el tratamiento médico adecuado constituye una buena alternativa de curación para algunos pacientes con tuberculosis pulmonar multirresistente.

show abstract

Role of surgery in multi-drug-resistant tuberculosis: results of 27 cases

Abstract: Our results indicate that surgical management of multi-drug resistant tuberculosis, combined with chemotherapy, provides a more favourable outcome than that obtained with medical therapy alone.

Cited by 31 publications

References 14 publications

Surgical treatment efficacy in 172 cases of tuberculosis-destroyed lungs

Surgical treatment efficacy in 172 cases of tuberculosis-destroyed lungs

Surgery for patients with drug-resistant tuberculosis: report of 121 cases receiving community-based treatment in Lima, Peru

Cirugía en tuberculosis pulmonar multirresistente.

Contact Info

Product

Resources

About