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

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 134; no. 1; pp. 194 - 198
• Main Authors: Mohsen, Tarek, MD, FRCS, Abou Zeid, Amany, MD, MRCP, Haj-Yahia, Saleem, MD, BSc
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.07.2007; AATS/WTSA; Elsevier
• Subjects: Adolescent; Adult; Bacterial diseases; Biological and medical sciences; Cardiothoracic Surgery; Child; Empyema - etiology; Empyema - therapy; Female; Follow-Up Studies; Hospital Mortality; Human bacterial diseases; Humans; Infectious diseases; Length of Stay; Male; Medical sciences; Middle Aged; Pneumonectomy - adverse effects; Pneumonectomy - methods; Postoperative Hemorrhage - etiology; Recurrence; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; Treatment Outcome; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Multidrug-Resistant - mortality; Tuberculosis, Multidrug-Resistant - surgery; Tuberculosis, Pulmonary - mortality; Tuberculosis, Pulmonary - surgery; 11; MDR-TB; 13; multidrug-resistant tuberculosis; 14; 15; Heart; Lung; Mycobacterial infection; Review; Institution; Epidemiology; Surgery; Multiple resistance; Bacteria; Pneumectomy; Treatment resistance; Mortality; Thorax; Morbidity; Infection; Experience; Treatment; Tuberculosis; Mycobacterium tuberculosis; Mycobacteriales; Bacteriosis; Mycobacteriaceae; Actinomycetes; Lobectomy; Bibliographic review
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2007.03.022

Objective 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. Methods 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. Results 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. Conclusion 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.