Abstract | BACKGROUND: Multidrug-resistant (MDR) and extensive drug-resistant (XDR) tuberculosis (TB) are still significant health problems. Surgical resection is an adjunctive intervention for patients with MDR or XDR TB. This study presents the short-term and long-term results of surgical treatment for MDR or XDR TB at a single center. METHODS: Between May 1996 and March 2008, surgical resection was performed on 72 patients with MDR or XDR TB at a single institution. Among these patients, 26 patients (36%) had XDR TB. All patients received multidrug regimens preoperatively and postoperatively. The preoperative sputum smears and cultures were positive in 52 patients (72%) and 58 patients (81%), respectively. The indications for surgery included failure of medical treatment in 51 patients (71%), localized disease or persistent cavity with high probability of relapse in 17 patients (24%), and combined complications such as hemoptysis in 4 patients (5%). RESULTS: Thirty-eight patients (53%) had a lobectomy with or without segmentectomy or wedge resection, 23 patients (32%) had pneumonectomies, 10 patients received segmentectomies, and 1 patient had multiple wedge resections. There was one postoperative death that was attributable to a thoracic empyema. Eight (11%) postoperative complications occurred, including empyema in 5 patients, bleeding in 2 patients, and postpneumonectomy syndrome in 1 patient. A favorable outcome was achieved in 65 patients (90%) after surgical resection. The favorable outcome rates did not differ significantly between patients with MDR TB and those with XDR TB (93% versus 85%; p = 0.244). CONCLUSIONS: Early pulmonary resection combined with chemotherapy had high cure rates with acceptable complications and preservation of the lung parenchyma in MDR TB and XDR TB.
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Authors | Min-Woong Kang, Hong Kwan Kim, Yong Soo Choi, Kwhanmien Kim, Young Mog Shim, Won-Jung Koh, Jhingook Kim |
Journal | The Annals of thoracic surgery
(Ann Thorac Surg)
Vol. 89
Issue 5
Pg. 1597-602
(May 2010)
ISSN: 1552-6259 [Electronic] Netherlands |
PMID | 20417785
(Publication Type: Journal Article)
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Copyright | Copyright (c) 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. |
Chemical References |
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Topics |
- Adult
- Antitubercular Agents
(therapeutic use)
- Cohort Studies
- Combined Modality Therapy
- Drug Resistance, Multiple, Bacterial
- Female
- Follow-Up Studies
- Humans
- Korea
- Male
- Pneumonectomy
(adverse effects, methods)
- Postoperative Complications
(epidemiology, physiopathology)
- Retrospective Studies
- Risk Assessment
- Severity of Illness Index
- Survival Rate
- Treatment Outcome
- Tuberculosis, Multidrug-Resistant
(diagnosis, drug therapy, mortality, surgery)
- Tuberculosis, Pulmonary
(diagnosis, drug therapy, mortality, surgery)
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