ROLE OF SURGERY IN MULTI-DRUG-RESISTANT TUBERCULOSIS - RESULTS OF 27 CASES

Objective: To evaluate the results of resectional surgery as an adjuva nt therapy in multi-drug resistant tuberculosis. Methods: A total of 2 7 human immunodeficiency virus (HIV)-negative patients with multi-drug resistant tuberculosis underwent resectional surgery between 1993 and 1996. The lesions were bilateral in 16 cases, with a preponderance of cavities on one side. Out of 27 cases, 5 patients had unilaterally de stroyed lung; 20 patients underwent pneumonectomy (15 left, 5 right). Lobectomy operations included bilobectomy superior (n = 1), right lowe r lobectomy (n = 2), right upper lobectomy (n = 3), and left upper lob ectomy with superior segmentectomy (n = 1). Results: Because of haemor rhage, 2 cases who underwent a right and left pneumonectomy, respectiv ely, required revision on the first day. Bronchopleural fistula was fo und in 2 cases with left pneumonectomy. Apical residual space was left in one of the 3 patients who underwent right upper lobectomy. Retreat ment protocols resulted in negative cultures and smears in all patient s with an average duration of 4 months (1-6 months). A total of 4 pati ents (16%) completed a retreatment period of 18-24 months with negativ e cultures. Only 1 patient (3.7%) developed relapse in the 17th month of retreatment. Patients with negative cultures numbered 22 and contin ued receiving retreatment. Conclusions: Our results indicate that surg ical management of multi-drug resistant tuberculosis, combined with ch emotherapy, provides a more favourable outcome than that obtained with medical therapy alone. (C) 1997 Elsevier Science B.V.