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Ilhan Inci
Ali Atasalihi
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J Thorac Cardiovasc Surg 2006;131:693-696
© 2006 The American Association for Thoracic Surgery

General Thoracic Surgery

Adjuvant resectional surgery improves cure rates in multidrug-resistant tuberculosis

Altan Kir, MD a , * , Ilhan Inci, MD a , Tulay Torun, MD b , Ali Atasalihi, MD a , Kemal Tahaoglu, MD b

a Division of Thoracic Surgery, Sureyyapasa Center for Chest Diseases and Thoracic Surgery, Maltepe, Istanbul, Turkey
b Division of Chest Diseases, Sureyyapasa Center for Chest Diseases and Thoracic Surgery, Maltepe, Istanbul, Turkey

Received for publication June 16, 2005; revisions received September 6, 2005; accepted for publication September 28, 2005.

* Address for reprints: Altan Kir, MD, Manastir Yolu, G-19 Sokak Adaevleri D-3, 34940 Tuzla, Istanbul, Turkey. (Email: altank{at}veezy.com).

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.

Abbreviations and Acronyms BPF = bronchopleural fistula; MDR-TB = multidrug-resistant tuberculosis




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