Boston - American Association for Thoracic Surgery

AMERICAN ASSOCIATION FOR THORACIC SURGERY19. Aggressive Surgical Treatment of Multidrug-Resistant Tuberculosis inthe Extensive Drug Resistance EraYuji Shiraishi, Naoya Katsuragi, Hidefumi Kita, Yoshiaki Tominaga, Kota Kariatsumari,Takahito OndaChest Surgery, Fukujuji Hospital, Tokyo, JapanInvited Discussant: Alain ChapelierOBJECTIVE: Since extensively drug-resistant tuberculosis has emerged, adequatecontrol of drug-resistant tuberculosis is becoming increasingly important. Wereport on our experience in using adjuvant resectional surgery liberally as part ofaggressive treatment of patients with multidrug-resistant tuberculosis.METHODS: Between January 2000 and December 2006, 54 patients underwent59 pulmonary resections for multidrug-resistant tuberculosis. Five patients underwentmultiple resections (bilateral 3, ipsilateral 2). There were 41 males and 13females with a mean age of 46 years (range: 22 to 64 years). None of the patientswas HIV-positive. Isolates were resistant to 2 to 10 anti-tuberculosis drugs (mean:5.6 drugs). Multidrug regimens employing 3 to 7 drugs (mean: 4.6 drugs) were initiatedin all patients. Indications for surgery were a high risk of relapse in 35patients, persistent positive sputum in 18, and associated empyema in one. Proceduresperformed included completion pneumonectomy (3), pneumonectomy (17),bilobectomy (1), lobectomy (32), and segmentectomy (6). Bronchial stump wasreinforced with muscle flap in 52 resections.MONDAYAfternoonRESULTS: There was no operative mortality. Major postoperative complicationsincluded bronchopleural fistula (3) and empyema (2). All patients attainedsputum-negative status after the surgery. Relapse occurred in 5 patients. Three ofthem were converted by the second resection; one responded to resumption ofchemotherapy; and one remained positive. Late death occurred in 2 patients withoutevidence of relapse. Among 52 survivors, 51 (98%) were considered cured.CONCLUSION: Pulmonary resection under cover of state-of-the-art chemotherapyis safe and effective for patients with multidrug-resistant tuberculosis. Since acquisitionof resistance to additional drugs will likely be inevitable if relapse occurs, webelieve that liberal use of adjuvant resectional surgery is justified in patients whohave been converted by chemotherapy but are still at high risk of relapse.105