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Clin Infect Dis. 2016 Apr 1;62(7):887-895. doi: 10.1093/cid/ciw002. Epub 2016 Jan 12.

Surgery as an Adjunctive Treatment for Multidrug-Resistant Tuberculosis: An Individual Patient Data Metaanalysis.

Author information

1
Montreal Chest Institute, McGill University, Canada.
2
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.
3
Departments of Medicine and Academic Affairs, Denver Veterans Affairs Medical Center, Colorado.
4
Wan Fang Hospital, Taipei Medical University, Taiwan.
5
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
6
Section of Chest Surgery, Fukujuji Hospital, Tokyo, Japan.
7
Estonian Tuberculosis Registry, National Institute for Health Development, Tallinn.
8
Department of Internal Medicine, Seoul National University College of Medicine, South Korea.
9
Department of Infection & Tropical Medicine, Imperial College London, United Kingdom.
10
Laboratoire de Bacteriologie-Hygiene, University Pierre and Marie Curie, Paris, France.
11
Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
12
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

Abstract

BACKGROUND:

Medical treatment for multidrug-resistant (MDR)-tuberculosis is complex, toxic, and associated with poor outcomes. Surgical lung resection may be used as an adjunct to medical therapy, with the intent of reducing bacterial burden and improving cure rates. We conducted an individual patient data metaanalysis to evaluate the effectiveness of surgery as adjunctive therapy for MDR-tuberculosis.

METHODS:

Individual patient data, was obtained from the authors of 26 cohort studies, identified from 3 systematic reviews of MDR-tuberculosis treatment. Data included the clinical characteristics and medical and surgical therapy of each patient. Primary analyses compared treatment success (cure and completion) to a combined outcome of failure, relapse, or death. The effects of all forms of resection surgery, pneumonectomy, and partial lung resection were evaluated.

RESULTS:

A total of 4238 patients from 18 surgical studies and 2193 patients from 8 nonsurgical studies were included. Pulmonary resection surgery was performed on 478 patients. Partial lung resection surgery was associated with improved treatment success (adjusted odds ratio [aOR], 3.0; 95% confidence interval [CI], 1.5-5.9; I(2)R, 11.8%), but pneumonectomy was not (aOR, 1.1; 95% CI, .6-2.3; I(2)R, 13.2%). Treatment success was more likely when surgery was performed after culture conversion than before conversion (aOR, 2.6; 95% CI, 0.9-7.1; I(2)R, 0.2%).

CONCLUSIONS:

Partial lung resection, but not pneumonectomy, was associated with improved treatment success among patients with MDR-tuberculosis. Although improved outcomes may reflect patient selection, partial lung resection surgery after culture conversion may improve treatment outcomes in patients who receive optimal medical therapy.

KEYWORDS:

individual patient data; metaanalysis; multidrug resistant tuberculosis; pneumonectomy; thoracic surgery

PMID:
26757804
DOI:
10.1093/cid/ciw002
[Indexed for MEDLINE]

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