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Pulmonary resection for multi-drug resistant tuberculosis.

B J Pomerantz1, J C Cleveland, H K Olson

  • 1Department of Surgery and the Section of Thoracic Surgery, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.

The Journal of Thoracic and Cardiovascular Surgery
|March 10, 2001
PubMed
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Surgery for multi-drug resistant tuberculosis (MDR-TB) is effective. Pulmonary resection can eradicate infection in patients with localized disease or intolerance to medical therapy, with acceptable outcomes.

Area of Science:

  • Pulmonary Medicine
  • Infectious Diseases
  • Surgical Oncology

Background:

  • Mycobacterium tuberculosis remains a global health threat, with emerging multi-drug resistant tuberculosis (MDR-TB) strains posing significant challenges.
  • Complacency has contributed to the rise of highly resistant strains, increasing the risk of a worldwide epidemic.
  • Optimal treatment for MDR-TB often necessitates surgical intervention for infection eradication.

Purpose of the Study:

  • To evaluate the efficacy and safety of pulmonary resection as a treatment for multi-drug resistant tuberculosis.
  • To analyze outcomes, including morbidity and mortality, associated with surgical intervention in MDR-TB patients.

Main Methods:

  • A retrospective analysis of 172 patients who underwent 180 pulmonary resections over a 17-year period.

Related Experiment Videos

  • All patients had confirmed multi-drug resistant tuberculosis and received at least 3 months of medical therapy prior to surgery.
  • Surgical techniques included lobectomies and pneumonectomies, with frequent use of muscle flaps to manage residual spaces and bronchial stumps.

    • Main Results:

    • 98 lobectomies and 82 pneumonectomies were performed; 8 patients had multiple procedures.
    • Operative mortality was 3.3% (6/180), with causes including respiratory failure, cerebrovascular accidents, and myocardial infarction.
    • Post-operative sputum conversion was achieved in 98% of patients (4/2), with a mean follow-up of 7.6 years and late mortality of 6.8%.

    Conclusions:

    • Pulmonary resection is a vital adjunct to medical therapy for managing multi-drug resistant tuberculosis.
    • Surgery is indicated for localized disease, persistent sputum positivity, or medical therapy intolerance in MDR-TB patients.
    • Surgical treatment for MDR-TB can be performed with acceptable operative morbidity and mortality rates.