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| Aggressive Surgical Treatment of Multidrug-resistant Tuberculosis in the Extensive Drug Resistance Era | |
Yuji Shiraishi, Naoya Katsuragi, Hidefumi Kita, Yoshiaki Tominaga, Kota Kariatsumari, Takahito Onda; Chest Surgery, Fukujuji Hospital, Tokyo, Japan
Methods: Between January 2000 and December 2006, 54 patients underwent 59 pulmonary resections for multidrug-resistant tuberculosis. Five patients underwent multiple resections (bilateral 3, ipsilateral 2). There were 41 males and 13 females with a mean age of 46 years (range: 22 to 64 years). None of the patients was HIV-positive. Isolates were resistant to 2 to 10 anti-tuberculosis drugs (mean: 5.6 drugs). Multidrug regimens employing 3 to 7 drugs (mean: 4.6 drugs) were initiated in all patients. Indications for surgery were a high risk of relapse in 35 patients, persistent positive sputum in 18, and associated empyema in one. Procedures performed included completion pneumonectomy (3), pneumonectomy (17), bilobectomy (1), lobectomy (32), and segmentectomy (6). Bronchial stump was reinforced with muscle flap in 52 resections. Results: There was no operative mortality. Major postoperative complications included bronchopleural fistula (3) and empyema (2). All patients attained sputum-negative status after the surgery. Relapse occurred in 5 patients. Three of them were converted by the second resection; one responded to resumption of chemotherapy; and one remained positive. Late death occurred in 2 patients without evidence of relapse. Among 52 survivors, 51 (98%) were considered cured. Conclusion: Pulmonary resection under cover of state-of-the-art chemotherapy is safe and effective for patients with multidrug-resistant tuberculosis. Since acquisition of resistance to additional drugs will likely be inevitable if relapse occurs, we believe that liberal use of adjuvant resectional surgery is justified in patients who have been converted by chemotherapy but are still at high risk of relapse. Back to 2009 Annual Meeting Back to Program Outline Back to Main Program |
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