Pulmonary resection can improve treatment outcome in re-treatment pulmonary tuberculosis and its complications

Background: Pulmonary tuberculosis (TB) is a widely spread disease, usually treated by multidrug therapy, nevertheless there are increasing number of cases in which medical treatment fails and requires surgical intervention specially those with large cavitary lesions or persistent sputum positive for Ziehl Neelsen (ZN) stain. Our objective was to assess the role of pulmonary resection in treating certain cases of pulmonary TB and its outcome and morbidity. Methods: In this study 45 tuberculous patients were selected for pulmonary resection (patients with large cavitary lesions and persistent sputum positive for ZN stain, massive hemoptysis, relapsed TB and treatment failure patients). Twenty-eight lobectomies (18 lobectomy for patients with relapsed TB with large cavities, persistent sputum positive and 10 lobectomy for patients with massive hemoptysis). Fourteen elective pneumonectomy for patients with symptomatic destroyed lung and 3 completion pneumonectomy were carried out. Results: Thirty-five patients (78%) were sputum positive preoperatively and 31 patients (69%) had cavitary lesions radiologically, MDR-TB was found retrospectively in 16 patients. Mortality was 4.4%, and postoperative complications were encountered in 44.4% of the participants. Forty-three patients (95.5%) became sputum negative 3-9 months after surgery. Male sex, HCV infection, operation time, and intraoperative bleeding were predictive of bad outcome in this study. Conclusions: Surgery is effective when medical therapy fails to control pulmonary TB and its complications. MDR-TB patients are among those who benefit from pulmonary resection. Postoperative medical therapy is important to improve results and in achieving negative sputum conversion in TB patients including MDR-TB patients. (C) 2013 The Egyptian Society of Chest Diseases and Tuberculosis. Production and hosting by Elsevier B.V.