Pulmonary resection for multidrug-resistant tuberculosis: the Israeli experience (1998-2011)

Multidrug-resistant tuberculosis (MDR-1B) presents a difficult therapeutic problem due to the failure of medical treatment. Pulmonary resection is an important adjunctive therapy for selected patients with MDR-TB. To assess the efficacy of pulmonary resection in the management of MDR-TB patients. We...

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Bibliographic Details
Published in:The Israel Medical Association journal 2012-12, Vol.14 (12), p.733-736
Main Authors: Papiashvili, Michael, Barmd, Ilan, Sasson, Lior, Lidji, Moshe, Litman, Klementy, Hendler, Atara, Polanski, Vladimir, Treizer, Leiv, Bendayan, Daniele
Format: Article
Language:English
Subjects:
Adolescent
Adult
Antitubercular Agents - therapeutic use
Female
Follow-Up Studies
Humans
Incidence
Israel - epidemiology
Male
Middle Aged
Pneumonectomy - methods
Retrospective Studies
Survival Rate - trends
Treatment Outcome
Tuberculosis, Multidrug-Resistant - drug therapy
Tuberculosis, Multidrug-Resistant - epidemiology
Tuberculosis, Multidrug-Resistant - surgery
Tuberculosis, Pulmonary - drug therapy
Tuberculosis, Pulmonary - epidemiology
Tuberculosis, Pulmonary - surgery
Young Adult
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Summary:Multidrug-resistant tuberculosis (MDR-1B) presents a difficult therapeutic problem due to the failure of medical treatment. Pulmonary resection is an important adjunctive therapy for selected patients with MDR-TB. To assess the efficacy of pulmonary resection in the management of MDR-TB patients. We retrospectively reviewed the charts of MDR-TB patients referred for major pulmonary resections as part of a treatment strategy. The operations were performed in the departments of thoracic surgery at Assaf Harofeh and Wolfson Medical Centers. For the period under study, 13 years (1998-2011), we analyzed patients' medical history, bacteriological, medical and surgical data, morbidity, mortality, and short-term and long-term outcome. We identified 19 pulmonary resections (8 pneumonectomies, 4 lobectomies, 1 segmentectomy, 6 wedge resections) from among 17 patients, mostly men, with a mean age of 32.9 years (range 18-61 years). Postoperative complications developed in six patients (35.3%) (broncho-pleural fistula in one, empyema in two, prolonged air leakin two, and acute renal failure in one). Only one patient (5.84%) died during the early postoperative period, three (17.6%) inthe late postoperative period, and one within 2 years after the resection. Of 12 survivors, 9 were cured, 2 are still under medical treatment, and 1 is lost from follow-up because of poor compliance. Pulmonary resection for MDR-TB patients is an effective adjunctive treatment with acceptable morbidity and mortality.
ISSN:1565-1088