Adjuvant resectional surgery improves cure rates in multidrug-resistant tuberculosis

Objective: Multidrug- resistant tuberculosis still continues to be a major health problem. Adjuvant surgical resection combined with antituberculous drug management is the most favorable treatment modality for patients with multidrug- resistant tuberculosis. In this article we report the results of surgical resections we performed during the years 1993 through 2005. Methods: We performed 81 lung resections in 79 patients with multidrug- resistant tuberculosis. All these patients had at least 2 months of medical therapy before resection. Bronchial reinforcement was performed in 4 of the 81 operations. We present here the surgical results of the 81 procedures. Because 5 of 79 patients were lost to follow- up, we provide the medical treatment results on 74 of the patients. Results: During this period, we performed 4 completion pneumonectomies, 39 pneumonectomies, 7 lobectomies with segmentectomy, 30 lobectomies, and 1 segmentectomy. Operative mortality was 2.5% ( 2/ 81). Bronchopleural fistula developed in 4 ( 4.9%) cases. Our overall cure rate was 94.5% ( 70/ 74). Relapse and treatment failure were 1.3% ( 1/ 74) and 1.3% ( 1/ 74), respectively. All but 5 patients are still under our follow- up. Conclusions: Surgical resection of patients with multidrug- resistant tuberculosis combined with chemotherapy provides a favorable outcome. Our results will need to be validated more strongly by using randomized clinical trials that compare surgical resection plus chemotherapy with chemotherapy alone.