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Lung Resection for Multidrug-Resistant Tuberculosis

Cardiothoracic Surgery, Inkosi Albert Luthuli Central Hospital Mayville, South Africa

For reprint information contact: Rishen Naidoo, MBChB Tel: 27 31 240 2114 Fax: 27 31 240 2113 Email: rishendran{at}mweb.co.za, Cardiothoracic Surgery, Inkosi Albert Luthuli Central Hospital, Private Bag X03, Mayville 4058, South Africa.

The emergence of multidrug-resistant tuberculosis poses a serious challenge to traditional drug therapy. In view of the relapse rate of up to 50% following medical management, there has been renewed interest in the role of surgery for this problem. We report our experience with lung resection for this condition. Over a 5-year period, resection was performed in 23 patients who were diagnosed with multidrug resistance after completing a course of standard chemotherapy and at least 3 months of second-line therapy. Pneumonectomy was performed in 17 patients and lobectomy in 6. There was no operative or postoperative mortality. Major complications developed in 4 patients (17.4%): 2 had post-pneumonectomy empyema and 2 underwent rethoracotomy for bleeding. Ten patients were sputum positive preoperatively, and only 1 remained positive after surgery. The patients were put on appropriate chemotherapy and followed up for 18 months. The cure rate was 95.6%. Pulmonary resection can be considered as an important adjunct to medical therapy in carefully selected patients: those who have localized disease with adequate pulmonary reserve, or who have multiple previous relapses, or whose sputum remains positive after 4 to 6 months of appropriate medical treatment. Surgery offers high cure rates with acceptable morbidity and mortality.

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				J. M Gimferrer and C. A Mestres Role of Surgery in Drug-Resistant Pulmonary Tuberculosis Asian Cardiovasc Thorac Ann, September 1, 2005; 13(3): 201 - 202. [Full Text] [PDF]