Tuberc Respir Dis.  2000 Dec;49(6):676-683. 10.4046/trd.2000.49.6.676.

The Role of Resectional Surgery for the Treatment of Localized Multi-drug Resistant Pulmonary Tuberculosis

• An CH
• Ahn JW
• Kang KW
• Kang SJ
• Lim YH
• Suh GY
• Chung MP
• Kim HJ
• Kwon OJ
• Rhee CH

• KMID: 2160302
• DOI: http://doi.org/10.4046/trd.2000.49.6.676

Abstract

BACKGROUND
Surgery may have a role when medical treatment alone is not successful in patients with multi-drug resistant (MDR) pulmonary tuberculosis (PTB). To document the role of resection in MDR PTB, we analyzed 4 years of our experience.
METHODS
A retrospective review was performed on thirteen patients that underwent pulmonary resection for MDR PTB between May 1996 and February 2000. All patients had organisms resistant to many of the first-line drugs including isoniazid (INH) and rifampicin (RFP).
RESULTS
The thirteen patients were 37.5±12.4 years old (mean±S.D.)(M:F=5:8), and their sputum was culture positive even with adequate medication for prolonged periods (109.7±132.0 months), resistant to 2-8 drugs including isoniazid and rifampin. All patients had localized lesion(s) and most (92.3%) had cavities. At least 3 sensitive anti-TB medications were started before surgery in all patients according to the drug sensitivity test. The preoperative FE1 was 2.37±0.83 L. Lobectomy was performed in 11 patients and pleuropneumonectomy in two. Postoperative mortality did not occur, but pneumonia occurred as a complication in one (7.7%). After 41.5±58.9 days (range 1~150 days) follow up, negative conversion of sputum culture was achieved in all patients within 5 months. Only one patient (7.7%) recurred 32 months after lung resection.
CONCLUSION
When medical treatment alone is not successful, surgical resection can be a good treatment option in patients with localized MDR PTB.

Keyword

Multi-drug resistant pulmonary tuberculosis; Surgery

MeSH Terms

Follow-Up Studies
Humans
Isoniazid
Lung
Mortality
Pneumonia
Retrospective Studies
Rifampin
Sputum
Tuberculosis, Pulmonary*
Isoniazid
Rifampin