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Surgical treatment for multidrug-resistant and extensive drug-resistant tuberculosis.

AbstractBACKGROUND:
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.
AuthorsMin-Woong Kang, Hong Kwan Kim, Yong Soo Choi, Kwhanmien Kim, Young Mog Shim, Won-Jung Koh, Jhingook Kim
JournalThe Annals of thoracic surgery (Ann Thorac Surg) Vol. 89 Issue 5 Pg. 1597-602 (May 2010) ISSN: 1552-6259 [Electronic] Netherlands
PMID20417785 (Publication Type: Journal Article)
CopyrightCopyright (c) 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Chemical References
  • Antitubercular Agents
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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