Prognostic factors for surgical resection in patients with multidrug-resistant tuberculosis

Abstract

Although surgical lung resection could improve prognosis in some patients with multidrug-resistant tuberculosis (MDR-TB), there are no reports on the optimal candidates for this surgery. The aim of the present study was to elucidate the prognostic factors for surgery in patients with MDR-TB.Patients who underwent lung resection for the treatment of MDR-TB between March 1993 and December 2004 were included in the present study. Treatment failure was defined as greater than or equal to two of the five cultures recorded in the final 12 months of treatment being positive, any one of the final three cultures being positive, or the patient having died during treatment. The variables that affected treatment outcomes were identified through univariate and multivariate logistic regression analysis.In total, 79 patients with MDR-TB were included in the present study. The treatment outcomes of 22 (27.8%) patients were classified as failure. A body mass index ,18.5 kg?m -2 , primary resistance, resistance to ofloxacin and the presence of a cavitary lesion beyond the range of the surgical resection were associated with treatment failure. Low body mass index, primary resistance, resistance to ofloxacin and cavitary lesions beyond the range of resection are possible poor prognostic factors for surgical lung resection in multidrug-resistant tuberculosis patients.

Adjunctive resectional lung surgery for extensively drug-resistant tuberculosis

“…Compared to previous studies of surgery, the present series of patients shows similar chest radiographic findings and a similar duration of therapy following surgery [12][13][14]. Previous studies report a longer duration of medical therapy before surgery, with medians ranging from 14 months to several years.…”

Treatment of tuberculosis: update 2010

“…In experienced hands, the outcome of lung resection has been found to be rather rewarding. The cure rates could reach o90% with postsurgery chemotherapy (table 5) [209][210][211][212][213][214][215][216][217][218][219][220][221][222]. In resource-limited areas, the cure rates might be lower (63-75%), but lung resection still appears useful as adjunctive management for this formidable disease [218].…”

“…Regarding the factors governing outcome of surgery for drugresistant tuberculosis, a low body mass index (,18.5 kg?m -2 ), bacillary resistance to fluoroquinolones and presence of cavity beyond the range of surgical resection portended poor prognosis in a carefully performed study [219]. The major complications of surgical treatment of pleuropulmonary tuberculosis include bronchopleural fistula, residual space problems and empyema.…”

Impact of resistance to first-line and injectable drugs on treatment outcomes in MDR-TB

“…In addition, the criteria for surgical resection were MDR-TB refractory to o6 months of medical treatment with a primary localised lesion [13].…”