Surgery for patients with drug-resistant tuberculosis: report of 121 cases receiving community-based treatment in Lima, Peru
- Jose G Somocurcio1,
- Alfredo Sotomayor1,
- Sonya Shin2,
- Silvia Portilla1,
- Maria Valcarcel1,
- Dalia Guerra3,
- Jennifer Furin2
- 1Ministerio de Salud, Lima, Perú
- 2Division of Social Medicine and Health Inequalities, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- 3Socios en Salud, Lima, Peru
- Correspondence to:
Dr Jennifer Furin
Brigham and Women’s Hospital, Division of Social Medicine and Health Inequalities, 1620 Tremont Street, Third Floor, Boston, Massachusetts 02120, USA;
- Received 25 August 2005
- Accepted 15 June 2006
- Published Online First 23 August 2006
Background: While most 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. The need for physical, technical and financial resources presents a potential challenge to implementing surgery as a component of treatment for multidrug-resistant TB (MDR-TB) in resource-poor settings. However, a cohort of patients with severe MDR-TB in Lima, Peru underwent surgery as part of their treatment.
Methods: 121 patients underwent pulmonary surgery for drug-resistant tuberculosis between May 1999 and January 2004. Surgery was performed by a team of thoracic surgeons under the Ministry of Health. Patient demographic data, clinical characteristics, surgical procedures and surgical outcomes were studied.
Results: Most of the patients had failed multiple TB regimens and were resistant to a median of seven drugs. The median time of follow-up after surgery was 33 months. 79.3% of patients were culture-positive before surgery, and sustained culture-negative status among survivors was achieved in 74.8% of patients. 63% of those followed up for at least 6 months after surgery were either cured or probably cured. Postoperative complications, observed in 22.6% of patients, were associated with preoperative haemoptysis, vital capacity <50% and low forced expiratory volume in 1 s.
Conclusions: This is one of the largest cohorts with MDR-TB to be treated with surgery, and the first from a resource-poor country. Although surgery is not often considered an option for patients in resource-poor settings, the findings of this study support the argument that adjunctive surgery should be considered an integral component of MDR-TB treatment programmes, even in poor countries such as Peru.
Published Online First 23 August 2006
This study was funded by grants from the Bill and Melinda Gates Foundation and the Thomas J White Foundation.
Competing interests: None.