Surgery Offers High Cure Rates in Multidrug-resistant Tuberculosis

Abstract

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.

Surgical Management of Pulmonary Mycobacterial Disease

“…The outcomes of resectional surgery for MDRTB disease are summarized in ►Table 3, which depicts results from the Table 3 Case series, surgery for MDRTB/XDRTB 8,9,[11][12][13][14][33][34][35][36] n XDRTB (%) Morbidity (%) Mortality (%) Cure rate (%) (negative sputum) larger case series in the literature. 8,9,[11][12][13][14][33][34][35][36] In general, these operations, despite their complexity, may be performed with low morbidity and mortality. Some of the reported differences may be attributed to the varying patient populations, operations described, and health care systems.…”

Comparative Evaluation of Treatment for Multi drug Resistant Tuberculosis with and without Surgical Resection: A Systematic Review–Meta Analysis of Retrospective Clinical Data

“…Figure 1 shows the overall success rate value with 95% CI and the observed result was higher for the surgical group (0.845, p=0.000) than the overall success rate of patients without surgery (0.520, p=0.031). The rate of occurrence of failure with 95% CI shown in Figure 2 and the analysis result shows higher overall rate of failure ( 0.157, p=0.00) for the same number of non-surgical patients and lower rate of failure for the surgical group, ( 0.100, p=0.00) [25][26][27][28][29]. Regarding to the rate of death, the overall value of death rate was 0.172, p=0.00, with heterogeneity values, I 2 =87.44 (p=0.00) and Chi squared based Q value of 79.62 with 10 df was observed in nonsurgical group.…”

Drug Regimen for Patients after a Pneumonectomy

“…To date, there has been no study exclusively focused on post-pneumonectomy TB patients. However, several studies including a great portion of pneumonectomy patients have reported successful outcomes of adjuvant anti-TB chemotherapy [10,[99][100][101][102][103][104]. TB patients were considered as cured when acid-fast bacilli (AFB) negative sputum conversion was produced throughout 18 months of treatments.…”

“…TB patients were considered as cured when acid-fast bacilli (AFB) negative sputum conversion was produced throughout 18 months of treatments. All of these studies achieved at least 90% of AFB negative sputum conversion/overall cure rates with appropriate chemotherapy after pulmonary resection [10,[99][100][101][102][103][104]. Adjuvant anti-TB chemotherapy usually lasted for 6 months, with the median duration of 18 months [10,99,100,103].…”