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Right arrow Minimally invasive surgery

J Thorac Cardiovasc Surg 2004;128:523-528
© 2004 The American Association for Thoracic Surgery

Resectional surgery combined with chemotherapy remains the treatment of choice for multidrug-resistant tuberculosis

Yuji Shiraishi, MD*, Yutsuki Nakajima, MD, Naoya Katsuragi, MD, Makoto Kurai, MD, Nobumasa Takahashi, MD

Section of Chest Surgery, Fukujuji Hospital, Tokyo, Japan

Read at the Eighty-fourth Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, April 25-28, 2004.

Received for publication April 11, 2004; revisions received May 23, 2004; accepted for publication June 16, 2004.

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

OBJECTIVE: Multidrug-resistant tuberculosis remains a significant health problem. The best available treatment for multidrug-resistant tuberculosis is the combination of pulmonary resection and antituberculous chemotherapy. We herein report the results of pulmonary resection combined with chemotherapy for multidrug-resistant tuberculosis at our institution during the years 2000 through 2002.

METHODS: Between 1983 and 2002, 87 patients underwent 95 pulmonary resections for multidrug-resistant tuberculosis. Of these, the 30 (34%) patients operated on from January 1, 2000, to December 31, 2002, are reviewed in the present study. All patients were maintained on multidrug regimens preoperatively and postoperatively. Indications for surgical intervention included persistently positive sputum and a high risk of relapse. Thirty-three pulmonary resections were performed, consisting of pneumonectomy (n = 12), lobectomy (n = 17), and segmentectomy (n = 4). The bronchial stump was reinforced with a latissimus dorsi muscle flap in 29 resections.

RESULTS: There was no operative mortality. Bronchopleural fistulas occurred in 2 patients. Five patients had a space problem. All patients attained sputum-negative status after the operation. Relapse occurred in 3 patients: 2 had a relapse at the bronchial stump, and the remaining patient had a relapse in the postlobectomy space. One late death occurred. Of the 29 survivors, 27 (93%) were free from disease, with a median follow-up of 24 months (range, 8-47 months).

CONCLUSIONS: An increasing number of patients with multidrug-resistant tuberculosis are requiring resectional surgery in the 21st century. Pulmonary resection combined with chemotherapy achieves high cure rates with acceptable morbidity and remains the treatment of choice for multidrug-resistant tuberculosis.

Keywords 11




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