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J Thorac Cardiovasc Surg 2007;134:194-198
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Lobectomy or pneumonectomy for multidrug-resistant pulmonary tuberculosis can be performed with acceptable morbidity and mortality: A seven-year review of a single institution’s experience

^a Department of Cardiothoracic Surgery, Kasr El Aini Hospital, Cairo University, Cairo, Egypt
^b Department of Chest Medicine, Kasr El Aini Hospital, Cairo University, Cairo, Egypt
^c Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospital, National Heart and Lung Institute, Imperial College London, United Kingdom

Received for publication November 15, 2006; revisions received February 13, 2007; accepted for publication March 29, 2007.

^_* Address for reprints: Saleem Haj-Yahia, MD, BSc, Cardiothoracic Transplantation Surgery and Mechanical Circulatory Support, Royal Brompton & Harefield Hospital, National Heart & Lung Institute, Imperial College London, London, United Kingdom. (Email: s.haj-yahia{at}imperial.ac.uk).

Objective: Combination chemotherapy is considered the first-line treatment for pulmonary tuberculosis. Despite related morbidity, the need for surgical resections coincides with the emergence of multidrug-resistant tuberculosis. This study presents a single-institution retrospective audit of the surgical management of 23 patients with multidrug-resistant tuberculosis.

Methods: We analyzed 23 consecutive patients undergoing anatomic pulmonary resections for human immunodeficiency virus–negative multidrug-resistant tuberculosis. Twenty were male (87%) and 3 were female (13%); their mean age was 24.4 years. We defined resistance in this cohort as failure to respond to combination chemotherapy, including isoniazid and rifampicin, with a mean duration of administration being 90 days. Fifteen of 23 (65.3%) patients, although sputum negative, were considered at risk for relapse owing to extensive parenchymal disease. Eight (34.7%) of 23 patients were sputum positive at the time of operation. We performed pneumonectomy on 11 (47.8%) and lobectomy on 12 (52%) patients. All had adjuvant chemotherapy for 18 to 24 months, with follow-ups ranging from 14 to 27 months.

Results: Stay in the intensive treatment unit was 2.9 days (range 1–17 days) and hospital stay, 8.6 days (range 5–45 days). Four (17%) patients had prolonged air leak, 3 (13%) required further treatment for empyema, with re-exploration for bleeding in 1 (4%). Hospital mortality was 4.3%. All patients attained sputum-negative status postoperatively (range 1-5 months). One (4%) patient had a relapse after 12 months.

Conclusion: Surgery should be considered as an adjunct to medical therapy when eradicating multidrug-resistant tuberculosis in affected patients. Anatomic lung resections can be performed with acceptable morbidity and mortality. Early referral of such patients for surgical consideration is warranted.

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