Surgical Treatment of Complications of Pulmonary Tuberculosis, including Drug-Resistant Tuberculosis

Abstract

Surgery for drug-resistant tuberculosis has been shown to be safe and effective, with similar level of mortalities associated with surgical intervention observed with that for lung cancer. While surgery has been an option to treat TB in the pre-antibiotic era, it is now increasingly used to treat complications of pulmonary TB, particularly in patients with drug-resistant TB who do not respond to medical treatment. The two most frequent indications for lung resection in drug- resistant TB, are i) failed medical treatment with persistent sputum positivity or ii) patients who have had medical treatment and are sputum negative, but with persistent localized cavitary disease or bronchiectasis. Massive hemoptysis is a potentially life-threatening complication of TB. Lung resection is potentially curative in patients with massive hemoptysis and cavitary or bronchiectatic disease. Bronchial artery embolization in these patients has a high success rate but bears also the risk of recurrence. Lung resection can be safely undertaken in selected patients with HIV co-infection and pulmonary complications of TB. Ambulatory drainage is a novel, safe, affordable and effective method of draining a chronic TB associated empyema thoracis. We review here the current surgical treatment of the complications of pulmonary TB and discuss the experience from the Durban Cardiothoracic Surgery Unit for the surgical treatment of patients with complicated pulmonary TB.

Current Indications and Outcome of Pulmonary Resections for Tuberculosis Complications in Ibadan, Nigeria

“…This supports the call for more interaction between cardiothoracic surgeons and pulmonary physicians to identify at an early stage patients who may benefit from surgery [11]. Similar to findings in our series, other authors have also reported haemoptysis as the commonest indication for intervention in patients with TB, although they intervened earlier with emergency surgeries in cases of massive haemoptysis [5,9,12].…”

“…We used a double-lumen tube to achieve one-lung ventilation for all our lung resections to improve exposure and protect the contralateral lung from soilage [14]. We placed 2 of our patients on anti-TB therapy in line with postoperative histological diagnosis because the effect of TB is usually beyond the resected lungs [5,15,16].…”

“…There is a need for further interaction with the local MDRTB centre for us to jointly identify patients who may benefit from pulmonary resection as a curative option. Further collaboration with the centre in our hospital will be important, as present-day pulmonary resection combined with anti-TB chemotherapy for MDRTB is reported to achieve high treatment success rates (88-95% of cases) [5,7,[17][18][19]. In the case of bilateral lesions, resection is recommended on the side with the greater lesions [6].…”

“…Following the advent of effective chemotherapy in the 1950s, surgical resection of the affected lung, which used to be the treatment of choice, faded into the background [4]. However, currently, lung resection is increasingly used to treat complications of pulmonary TB and multidrug-resistant TB (MDRTB) [4,5]. Complications of TB amenable to surgical resection of the lung include massive haemoptysis, bronchiectasis, bronchial stenosis, bronchopleural fistula, and aspergilloma [5].…”

“…However, currently, lung resection is increasingly used to treat complications of pulmonary TB and multidrug-resistant TB (MDRTB) [4,5]. Complications of TB amenable to surgical resection of the lung include massive haemoptysis, bronchiectasis, bronchial stenosis, bronchopleural fistula, and aspergilloma [5].…”