Pulmonary resection in the treatment of patients with pulmonary multidrug-resistant tuberculosis in Taiwan

SETTING: Chronic Disease Control Bureau, Department of Health, Taiwan. OBJECTIVE: To evaluate the role of pulmonary resection in the treatment of pulmonary tuberculosis resistant to isoniazid and rifampin (MDR-TB). DESIGN: In a retrospective cohort study, 27 MDR-TB patients who underwent p ulmonary resection between December 1990 and March 1999 were reviewed. Indi vidually-tailored treatment regimens were selected at a once-weekly staff c onference following review of the patient's case history and drug susceptib ility results. Surgery was performed for selected patients, essentially tho se: 1) whose medical treatment had failed, or for whom treatment failure se emed highly likely, or for whom posttreatment relapse seemed likely, 2) wit h predominantly localised disease, 3) with adequate cardiopulmonary reserve , and 4) whose treatment regimen had been composed of at least two effectiv e drugs to diminish the mycobacterial burden. RESULTS: There was no surgical mortality apart from one peri-operative deat h (4%). Three patients (11%) developed complications, and 24 (92%) patients demonstrated sputum conversion and/or remained negative after surgery. Twe nty-three patients have already completed treatment, and during a mean of 4 2 +/- 18 followup months (range 15-80 months), one patient relapsed. This p atient was disease-free after another course of treatment. CONCLUSION: For selected patients, pulmonary resection may improve the outc ome of pulmonary MDR-TB.