Role of surgery in multi-drug-resistant tuberculosis: results of 27 cases.

Objective: To evaluate the results of resectional surgery as an adjuvant therapy in multi-drug resistant tuberculosis.

Methods: A total of 27 human immunodeficiency virus (HIV)-negative patients with multi-drug resistant tuberculosis underwent resectional surgery between 1993 and 1996. The lesions were bilateral in 16 cases, with a preponderance of cavities on one side. Out of 27 cases, 5 patients had unilaterally destroyed lung; 20 patients underwent pneumonectomy (15 left, 5 right). Lobectomy operations included bilobectomy superior (n = 1), right lower lobectomy (n = 2), right upper lobectomy (n = 3), and left upper lobectomy with superior segmentectomy (n = 1).

Results: Because of haemorrhage, 2 cases who underwent a right and left pneumonectomy, respectively, required revision on the first day . Bronchopleural fistula was found in 2 cases with left pneumonectomy. Apical residual space was left in one of the 3 patients who underwent right upper lobectomy. Retreatment protocols resulted in negative cultures and smears in all patients with an average duration of 4 months (1-6 months). A total of 4 patients (16%) completed a retreatment period of 18-24 months with negative cultures. Only 1 patient (3.7%) developed relapse in the 17th month of retreatment. Patients with negative cultures numbered 22 and continued receiving retreatment.

Conclusions: Our results indicate that surgical management of multi-drug resistant tuberculosis, combined with chemotherapy, provides a more favourable outcome than that obtained with medical therapy alone.