@article {Somocurcio416, author = {Jose G Somocurcio and Alfredo Sotomayor and Sonya Shin and Silvia Portilla and Maria Valcarcel and Dalia Guerra and Jennifer Furin}, title = {Surgery for patients with drug-resistant tuberculosis: report of 121 cases receiving community-based treatment in Lima, Peru}, volume = {62}, number = {5}, pages = {416--421}, year = {2007}, doi = {10.1136/thx.2005.051961}, publisher = {BMJ Publishing Group Ltd}, abstract = {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.}, issn = {0040-6376}, URL = {https://thorax.bmj.com/content/62/5/416}, eprint = {https://thorax.bmj.com/content/62/5/416.full.pdf}, journal = {Thorax} }