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• W1969989076 abstract "ObjectiveCombination chemotherapy is considered the first-line treatment for pulmonary tuberculosis. Despite related morbidity, the need for surgical resections coincides with the emergence of multidrug-resistant tuberculosis. This study presents a single-institution retrospective audit of the surgical management of 23 patients with multidrug-resistant tuberculosis.MethodsWe analyzed 23 consecutive patients undergoing anatomic pulmonary resections for human immunodeficiency virus–negative multidrug-resistant tuberculosis. Twenty were male (87%) and 3 were female (13%); their mean age was 24.4 years. We defined resistance in this cohort as failure to respond to combination chemotherapy, including isoniazid and rifampicin, with a mean duration of administration being 90 days. Fifteen of 23 (65.3%) patients, although sputum negative, were considered at risk for relapse owing to extensive parenchymal disease. Eight (34.7%) of 23 patients were sputum positive at the time of operation. We performed pneumonectomy on 11 (47.8%) and lobectomy on 12 (52%) patients. All had adjuvant chemotherapy for 18 to 24 months, with follow-ups ranging from 14 to 27 months.ResultsStay in the intensive treatment unit was 2.9 days (range 1–17 days) and hospital stay, 8.6 days (range 5–45 days). Four (17%) patients had prolonged air leak, 3 (13%) required further treatment for empyema, with re-exploration for bleeding in 1 (4%). Hospital mortality was 4.3%. All patients attained sputum-negative status postoperatively (range 1-5 months). One (4%) patient had a relapse after 12 months.ConclusionSurgery should be considered as an adjunct to medical therapy when eradicating multidrug-resistant tuberculosis in affected patients. Anatomic lung resections can be performed with acceptable morbidity and mortality. Early referral of such patients for surgical consideration is warranted. Combination chemotherapy is considered the first-line treatment for pulmonary tuberculosis. Despite related morbidity, the need for surgical resections coincides with the emergence of multidrug-resistant tuberculosis. This study presents a single-institution retrospective audit of the surgical management of 23 patients with multidrug-resistant tuberculosis. We analyzed 23 consecutive patients undergoing anatomic pulmonary resections for human immunodeficiency virus–negative multidrug-resistant tuberculosis. Twenty were male (87%) and 3 were female (13%); their mean age was 24.4 years. We defined resistance in this cohort as failure to respond to combination chemotherapy, including isoniazid and rifampicin, with a mean duration of administration being 90 days. Fifteen of 23 (65.3%) patients, although sputum negative, were considered at risk for relapse owing to extensive parenchymal disease. Eight (34.7%) of 23 patients were sputum positive at the time of operation. We performed pneumonectomy on 11 (47.8%) and lobectomy on 12 (52%) patients. All had adjuvant chemotherapy for 18 to 24 months, with follow-ups ranging from 14 to 27 months. Stay in the intensive treatment unit was 2.9 days (range 1–17 days) and hospital stay, 8.6 days (range 5–45 days). Four (17%) patients had prolonged air leak, 3 (13%) required further treatment for empyema, with re-exploration for bleeding in 1 (4%). Hospital mortality was 4.3%. All patients attained sputum-negative status postoperatively (range 1-5 months). One (4%) patient had a relapse after 12 months. Surgery should be considered as an adjunct to medical therapy when eradicating multidrug-resistant tuberculosis in affected patients. Anatomic lung resections can be performed with acceptable morbidity and mortality. Early referral of such patients for surgical consideration is warranted." @default.
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• W1969989076 date "2007-07-01" @default.
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• W1969989076 title "Lobectomy or pneumonectomy for multidrug-resistant pulmonary tuberculosis can be performed with acceptable morbidity and mortality: A seven-year review of a single institution’s experience" @default.
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• W1969989076 doi "https://doi.org/10.1016/j.jtcvs.2007.03.022" @default.
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