Surgical Therapy for Patients with Drug-Resistant Tuberculosis: Report of 121 Cases Receiving Community- Based Treatment in Lima, Peru

Jose Somocurcio ¹, Alfredo Sotomayor ¹, Sonya Shin ², Silvia Portilla ¹, Maria valcarcel ¹, Dalia Guerra ³ and Jennifer J Furin ^2*

¹ Ministerio de Salud, Lima Perú, Peru
² Brigham and Women's Hospital, United Kingdom
³ Socios En Salud, Lima Perú, Peru

^* To whom correspondence should be addressed. E-mail: jfurin{at}partners.org.

Accepted 15 June 2006

Abstract

Introduction: While the majority of patients with tuberculosis (TB) can be successfully treated using short-course medical chemotherapy, thoracic surgery is an important adjunctive strategy for many patients with drug- resistant disease. Although the need for physical, technical and financial resources present a potential challenge to implementing surgery as a component of MDR- TB treatment in resource-poor settings, we report here on a cohort of patients with drug-resistant tuberculosis in Lima, Peru who underwent surgery as part of their treatment for severe MDR-TB.

Methods: A prospective case series of 121 patients undergoing pulmonary surgery for drug-resistant tuberculosis between May 1999 and January 2004 was performed. Surgery was performed by a team of thoracic surgeons under the Ministry of Health. Data was collected on patient demographics, clinical characteristics, surgical procedures, and surgical outcomes.

Results: A total of 121 patients underwent thoracic surgery during this study. Most had failed multiple TB regimens and were resistant to a median of seven drugs. Median time of follow-up after surgery was 33 months. 79.3% of patients were culture-positive prior to surgery, and sustained culture-negative status among survivors was achieved in 74.8% of patients. Among those with at least six months post-operative follow-up, 63% of patients are either cured or likely cured. Post-operative complications, observed in 22.6% of patients, were associated with pre-operative hemoptysis (p=0.03), vital capacity < 50% (p=0.004) and low forced expiratory volume in the first second (p=0.04).

Conclusions: The cohort in this study represents one of the largest surgical experiences with MDR-TB and the first from a resource-poor setting with patients treated under program conditions. Although surgery is not often considered an option for patients in resource-poor settings, our experience supports the argument that adjunctive surgery should be considered an integral component of MDR-TB treatment programs, even in poor countries such as Peru.

Keywords: drug resistance, peru, surgery, tuberculosis

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Role of surgery in pulmonary multidrug-resistant tuberculosis

L Peter Ormerod
Thorax 2007 62: 377. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Wilson, D., Hurtado, R. M., Digumarthy, S. (2009). Case 18-2009 -- A 24-Year-Old Woman with AIDS and Tuberculosis with Progressive Cough, Dyspnea, and Wasting. NEJM 360: 2456-2464 [Full Text]  
• Shiraishi, Y., Katsuragi, N., Kita, H., Toishi, M., Onda, T. (2008). Experience with pulmonary resection for extensively drug-resistant tuberculosis. ICVTS 7: 1075-1078 [Abstract] [Full Text]  
• Wang, H., Lin, H., Jiang, G. (2008). Pulmonary Resection in the Treatment of Multidrug-Resistant Tuberculosis: A Retrospective Study of 56 Cases. Ann. Thorac. Surg. 86: 1640-1645 [Abstract] [Full Text]  
• Mitnick, C. D., Shin, S. S., Seung, K. J., Rich, M. L., Atwood, S. S., Furin, J. J., Fitzmaurice, G. M., Alcantara Viru, F. A., Appleton, S. C., Bayona, J. N., Bonilla, C. A., Chalco, K., Choi, S., Franke, M. F., Fraser, H. S.F., Guerra, D., Hurtado, R. M., Jazayeri, D., Joseph, K., Llaro, K., Mestanza, L., Mukherjee, J. S., Munoz, M., Palacios, E., Sanchez, E., Sloutsky, A., Becerra, M. C. (2008). Comprehensive Treatment of Extensively Drug-Resistant Tuberculosis. NEJM 359: 563-574 [Abstract] [Full Text]  
• Yew, W. W., Leung, C. C. (2008). Update in Tuberculosis 2007. Am. J. Respir. Crit. Care Med. 177: 479-485 [Full Text]  
• Ormerod, L P. (2007). Role of surgery in pulmonary multidrug-resistant tuberculosis. Thorax 62: 377-377 [Full Text]