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. Copyright (c) 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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. Copyright (c) 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.