The value of surgical resection in patients with multidrug resistant tuberculosis

Thorac Cardiovasc Surg. 2009 Jun;57(4):222-5. doi: 10.1055/s-0029-1185458. Epub 2009 May 20.


Background: Multidrug resistant tuberculosis (MDR-TB) still continues to be a serious health problem throughout the world. Although main treatment of MDR-TB is medical, surgical resection with adjuvant medical therapy may increase the chance of cure in selected patients.

Methods: We performed surgical resections in 55 patients between 1997 and 2005; 36 were male and 19 were female with a median age of 34 years (range 13 to 66 years). Sputum was negative for 49 patients and positive for 6 patients in the preoperative period. Patients were treated according to a new therapy protocol for a mean of 3.7 months before the operation.

Results: Lobectomy was performed in 37 patients, pneumonectomy in 17 patients and lobectomy + segmentectomy in 1 patient. One patient with positive sputum preoperatively died in the early postoperative period (mortality: 1.81 %). Various complications occurred in 16 (29.09 %) patients. Prolonged air leak was the most common complication (n = 8). Bronchopleural fistula (BPF) + empyema occurred in 2 (3.63 %) patients. In the postoperative period, sputum negativity was achieved in all patients except three cases throughout the 57 months of follow-up (cure rate 94.5 %). Patients received drug therapy for 24 months postoperatively.

Conclusions: Surgical resection with adjuvant drug therapy increases the chance of cure in patients with localized disease if they have an adequate cardiopulmonary reserve, favorable nutritional status and are treated with a new therapy protocol for at least 3 months.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Chemotherapy, Adjuvant
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Pneumonectomy / methods
  • Postoperative Complications
  • Sputum / microbiology
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Tuberculosis, Multidrug-Resistant / diagnostic imaging
  • Tuberculosis, Multidrug-Resistant / drug therapy
  • Tuberculosis, Multidrug-Resistant / mortality
  • Tuberculosis, Multidrug-Resistant / surgery*
  • Tuberculosis, Pulmonary / diagnostic imaging
  • Tuberculosis, Pulmonary / drug therapy
  • Tuberculosis, Pulmonary / surgery*
  • Young Adult