Surgery increased the chance of cure in multi-drug resistant pulmonary tuberculosis

Background: Medical treatment of multiple drug resistant (MDR) pulmonary tu berculosis is generally quite unsuccessful. Recently, surgical management i s increasing and shows promise. We analyzed our experience to identify the benefits and complications of pulmonary resection in MDR pulmonary tubercul osis. Methods: A retrospective review was performed in 27 patients undergoi ng pulmonary resection for MDR pulmonary tuberculosis between January 1994 and March 1998. Their average ages were 40 years and were diagnosed a media n of 15 months before surgery. All patients had resistance to an average of 4.3 drugs including isoniazid and rifampin, and had received second line d rugs selected according to drug sensitivity test preoperatively. Most patie nts (92.6%) had cavitary lesions. Bilateral lesions were also identified in 19 patients (70.4%), but the main focus was recognized in one side of the lung. Most patients were indicated to operation for those who could not ach ieve negative sputum despite adequate medical treatment (n = 16, 59.3%); or for negative patients who had significant pulmonary parenchymal lesion (n = 11, 40.7%) which would have had a high probability of recurrence. Pneumon ectomy was done in nine patients, lobectomy in 16 and segmentectomy in two. Results: Then was no operative mortality. Morbidity occurred in seven pati ents (25.9%): prolonged air leakage in three patients, reoperation due to b leeding in two, bronchopleural fistula in one, and reversible blindness in one. The median follow up period was 15 months (range 3-45). Sputum negativ e conversion was achieved in 22 patients (81.5%) initially. However, contin ued postoperative chemotherapy could convert to negative in another four pa tients (14.8%). Only one pneumonectomy patient (3.7%) failed because of con siderable contralateral cavity. Conclusion: For patients with MDR pulmonary tuberculosis which is localized, and with adequate pulmonary reserve funct ion, surgical pulmonary resection combined with appropriate pre and postope rative anti-tuberculosis chemotherapy can achieve high success rate with ac ceptable morbidity. (C) 1999 Elsevier Science B.V. All rights reserved.