Journal
ANNALS OF THORACIC SURGERY
Volume 95, Issue 6, Pages 1892-1898Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.athoracsur.2013.03.067
Keywords
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Funding
- National Institutes of Health Fogarty International Center [D43TW007124, D43TW007124-06S1]
- Atlanta Clinical and Translational Science Institute [NIH/NCATS UL1TR000454]
- Emory Global Health Institute
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Background. New approaches are needed in the treatment of multidrug-resistant and extensively drugresistant pulmonary tuberculosis (M/XDR-PTB). We evaluated the role of adjunctive surgical therapy in the treatment of M/XDR-PTB in the setting of directly observed treatment strategy (DOTS)-Plus implementation. Methods. We conducted an observational cohort study consisting of M/XDR-PTB patients who underwent thoracic surgery at the National Tuberculosis Center in Tbilisi, Georgia between October 2008 and February 2011. Indications for surgery included presence of M/XDR-PTB, localized pulmonary disease, fit to undergo surgery, and either medical treatment failure or such extensive drug resistance that failure was likely. Secondline anti-tuberculosis medical therapy was administered per World Health Organization (WHO) recommendations. Results. Seventy-five patients (51 MDR, 24 XDR) with PTB underwent adjunctive thoracic surgery. Median age was 30 years and average duration of preoperative M/XDR-PTB medical therapy was 342 days. The following surgical procedures were performed: pneumonectomy (11%), lobectomy (54%), and segmentectomy (35%). Mean postoperative follow-up time was 372 days. Of 72 patients with evaluable outcomes, 59 (82%) had favorable outcomes including 90% of MDR and 67% of XDR-TB patients. There was no postoperative mortality; postoperative complications occurred in 7 patients (9%). Risk factors for poor treatment outcomes in univariate analysis included bilateral disease, XDR, increasing effective drugs received, positive preoperative sputum culture, and major postoperative surgical complication. Conclusions. Patients with M/XDR-PTB undergoing adjunctive thoracic surgery had high rates of favorable outcomes, no surgical-related mortality, and low rates of complications. Adjunctive surgery appears to play an important role in the treatment of select patients with M/XDR-PTB. (C) 2013 by The Society of Thoracic Surgeons
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