Original Articles

Pulmonary Resection for Multidrug-Resistant Tuberculosis: The Israeli Experience (1998–2011)

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Click on the icon on the upper right hand side for the article by Michael Papiashvili, MD, Ilan Bar, MD, Lior Sasson, MD, Moshe Lidji, MD, Klementy Litman, MD, Atara Hendler, MD, Vladimir Polanski, MD, Leiv Treizer, MD and Daniele Bendayan, MD.
IMAJ 2012: 14: December: 733-736
Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB) 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.


Objectives: To assess the efficacy of pulmonary resection in the management of MDR-TB patients.


Methods: We retrospectively reviewed the charts of MDR-TB patients referred for major pulmonary resections to the departments of thoracic surgery at Assaf Harofeh and Wolfson Medical Centers. For the period under study, 13 years (from 1998 to 2011), we analyzed patients’ medical history, bacteriological, medical and surgical data, morbidity, mortality, and short-term and long-term outcome.


Results: 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 leak in two, and acute renal failure in one). Only one patient (5.8%) died during the early postoperative period, three (17.6%) in the 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.


Conclusions: Pulmonary resection for MDR-TB patients is an effective adjunctive treatment with acceptable morbidity and mortality.