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J Thorac Cardiovasc Surg 2009;138:1180-1184
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Aggressive surgical treatment of multidrug-resistant tuberculosis

Section of Chest Surgery, Fukujuji Hospital, Tokyo, Japan

Received for publication April 7, 2009; revisions received June 3, 2009; accepted for publication July 5, 2009.

^_* Address for reprints: Yuji Shiraishi, MD, Section of Chest Surgery, Fukujuji Hospital, 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8522 Japan. (Email: yujishi{at}mvb.biglobe.ne.jp).

Objective: Because extensively drug-resistant tuberculosis has emerged, adequate control of drug-resistant tuberculosis has become increasingly important. We report on our experience using liberal adjuvant resectional surgery as part of aggressive treatment for multidrug-resistant tuberculosis.

Methods: We retrospectively reviewed the records of 56 consecutive patients who underwent pulmonary resections for multidrug-resistant tuberculosis between January 2000 and June 2007. There were 42 males and 14 females (mean age, 46 years; range, 22-64 years). Isolates were resistant to a mean of 5.6 drugs (range, 2-10 drugs). Multi-drug regimens employing 3 to 7 drugs (mean, 4.6 drugs) were initiated in all patients. Indications for surgery were a high risk of relapse for 37 patients, persistent positive sputum for 18, and 1 with associated empyema.

Results: The 56 patients underwent 61 pulmonary resections (3 completion pneumonectomies, 19 pneumonectomies, 33 lobectomies, and 6 segmentectomies). Bronchial stumps were reinforced with muscle flaps in 54 resections. Operative mortality and morbidity rates were 0% and 16%, respectively. All patients attained postoperative sputum-negative status. Relapse occurred in 5 patients; 3 were converted by a second resection, and 1 responded to augmentation of chemotherapy. Late death occurred for 2 patients without evidence of relapse. Among 54 survivors, 53 (98%) were considered cured.

Conclusion: Surgical treatment that complements medical treatment has proved safe and efficacious for patients with multidrug-resistant tuberculosis. In an era with extensively drug-resistant tuberculosis, an aggressive treatment approach to multidrug-resistant tuberculosis continues to be justified until a panacea for this refractory disease is available.

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