Bilateral cavitary multidrug- or extensively drug-resistant tuberculosis: role of surgery†

Marfina, Galina; Vladimirov, Kirill; Аветисян, А. О.; Старшинова, Анна; Kudriashov, Grigorii; Соколович, Е. Г.; Yablonskii, Piotr

doi:10.1093/ejcts/ezx350

Cited by 14 publications

(11 citation statements)

References 22 publications

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“…Multi-stage operations give a chance for recovering, while bilateral resections give hope to those who otherwise have no choice. While the published data on bilateral resections are encouraging (107), the devil, as usual, is in the details. One's lifelong experience and the old fox's seventh sense in patient selection are hard to explain in numbers like odd ratios and P values.…”

Section: Surgical Detailsmentioning

confidence: 97%

“…The place of resective surgery is open for discussion as there are many divergent opinions. Language barriers accepted, it is obvious that there is a distinct way, led by the robust Russian (and ex-Soviet Union states) experience (106,107), of favouring resection, while the majority of publications from the Far East show a more restrained attitude (100,(108)(109)(110). There is an understandably highly conservative attitude in the high income low incidence countries, a stance recently challenged by mass migration and global tourism.…”

Section: Indicationsmentioning

confidence: 99%

“…Frequently, more than one procedure is required (lobectomy/ pneumonectomy with thoracoplasty, parenchyma resection with decortication, same-stage cavernostomy and myoplasty, etc.). Fragile patients might benefit from staged procedures (106,107). Operations for bilateral lesions need significant functional reserve and good judgement (107).…”

Section: Surgical Detailsmentioning

confidence: 99%

“…Fragile patients might benefit from staged procedures (106,107). Operations for bilateral lesions need significant functional reserve and good judgement (107). Multi-stage operations give a chance for recovering, while bilateral resections give hope to those who otherwise have no choice.…”

Section: Surgical Detailsmentioning

confidence: 99%

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Tuberculosis: mother of thoracic surgery then and now, past and prospectives: a review

Molnár

2018

J. Thorac. Dis.

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Knowledge on ontogenesis of thoracic surgery is essential not only for understanding present concepts and debates on surgery for tuberculosis, but it also contributes to the further developments in operative treatment of lung cancer. Both diseases have been the leading cause of death in their respective ages. History of tuberculosis follows the classic algorithm: diagnostic, casuistic and therapeutical stages. Villemin followed by Virchow, and, finally, Koch revealed the pathoanatomy and the cause of tuberculosis. The therapeutic phase of lung cancer has been reached without identified cause of the disease. Chest surgery, eradication of the macroscopic focus by physical interference with the involved tissue mass, in both diseases preceded medical treatment. Identification of phenotypes of lung cancer-if it is a single disease at all-does not contravene the concept: the tumor mass should been eliminated. However, causation is not an absolute sine qua non of an effective treatment, as the tuberculosis-lung cancer analogy also proves. Surgical approach of both diseases suffered from the same paraoxon: eradication without direct interference with the causative factor. While lung cancer seems to be controlled by an emerging array of new drugs, tuberculosis poses a new challenge, as multidrug resistant and extensively drug resistant Koch bacteria are emerging and fragile societies' immunity is weakening. Thoracic surgery has a significant share in the fight against tuberculosis, when drugs and/or society fail. Palliative and radical adjuvant surgery multiplies the chance of cure in those cases, where not much hope is left. The jury is still out in a series of questions, but it is obvious, that surgery is only an option and not a panacea where medicines and their providers fail. Deeper understanding of our past and present failures with tuberculosis and its surgery might contribute to new concepts in coping with lung cancer as well.

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Section: Surgical Detailsmentioning

confidence: 97%

Section: Indicationsmentioning

confidence: 99%

Section: Surgical Detailsmentioning

confidence: 99%

Section: Surgical Detailsmentioning

confidence: 99%

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Tuberculosis: mother of thoracic surgery then and now, past and prospectives: a review

Molnár

2018

J. Thorac. Dis.

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“…In summary, all major guidelines are consistent in recommending surgery in selected cases, following chemotherapy and favouring elective partial lung resection when possible, based on specific indications: failure of drug therapy, relapse, localized (e.g., cavity) or extensive pulmonary TB, clinical complications (e.g., haemoptysis or empyema) [39]. However, recent evidence suggests that bilateral surgery can also be safe and effective [40].…”

Section: Evaluating the Role Of Surgery Through Ipdmentioning

confidence: 99%

Post-Tuberculosis (TB) Treatment: The Role of Surgery and Rehabilitation

et al. 2020

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Even though the majority of tuberculosis (TB) programmes consider their work completed when a patient is ‘successfully’ cured, patients often continue to suffer with post-treatment or surgical sequelae. This review focuses on describing the available evidence with regard to the diagnosis and management of post-treatment and surgical sequelae (pulmonary rehabilitation). We carried out a non-systematic literature review based on a PubMed search using specific key-words, including various combinations of ‘TB’, ‘MDR-TB’, ‘XDR-TB’, ‘surgery’, ‘functional evaluation’, ‘sequelae’ and ‘pulmonary rehabilitation’. References of the most important papers were retrieved to improve the search accuracy. We identified the main areas of interest to describe the topic as follows: 1) ‘Surgery’, described through observational studies and reviews, systematic reviews and meta-analyses, IPD (individual data meta-analyses), and official guidelines (GRADE (Grading of Recommendations Assessment, Development and Evaluation) or not GRADE-based); 2) Post-TB treatment functional evaluation; and 3) Pulmonary rehabilitation interventions. We also highlighted the priority areas for research for the three main areas of interest. The collection of high-quality standardized variables would allow advances in the understanding of the need for, and effectiveness of, pulmonary rehabilitation at both the individual and the programmatic level. The initial evidence supports the importance of the adequate functional evaluation of these patients, which is necessary to identify those who will benefit from pulmonary rehabilitation.

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