Partial lung resection in addition to antibiotic therapy improved treatment outcomes among patients with multidrug-resistant tuberculosis, according to recent data.
“In the pre-antibiotic era, surgical procedures aiming to reduce bacterial load in diseased lungs were a mainstay of TB therapy,” Gregory J. Fox, MD, PhD, from the Montreal Chest Institute at McGill University, and colleagues wrote. “After the advent of effective medical therapies in the 1960s, surgical treatment of TB was abandoned in many parts of the world, except for management of serious complications.
“As highly drug-resistant TB has re-created the conditions of the pre-antibiotic era, surgical resection for TB may have an important role in treating carefully selected patients for whom medical therapy alone is likely to be inadequate.”
Fox and colleagues performed an individual patient data meta-analysis of 26 studies to examine the effect of lung resection surgery on treatment failure, relapse and death in patients with bacteriologically confirmed multidrug-resistant (MDR)-TB. They examined data on 6,431 patients who underwent pneumonectomy (n = 117) and partial lung resection, including lobectomy or segmentectomy (n = 229), and compared their outcomes with patients who did not receive surgical treatment.
Overall, treatment success was greater in surgical patients (69%; 95% CI, 63%-75%) vs. nonsurgical patients (60%; 95% CI, 51%-70%). Further analysis showed that partial lung resection increased the odds of treatment success (adjusted OR = 3; 95% CI, 1.5-5.9), compared with nonsurgery, although pneumonectomy did not.
“The main explanation for improved treatment outcomes with partial lung resection appears to relate to a lower mortality rate among surgical patients than patients treated with anti-tuberculosis medications alone,” Fox and colleagues wrote.
Treatment success rates also were higher when surgery was performed after culture conversion (aOR = 2.6; 95% CI, 0.9-7.1), suggesting that surgery was more beneficial after an effective antibiotic regimen was established, the researchers wrote. – by Stephanie Viguers
Disclosure: Fox reports receiving an award supported by Otsuka and the International Union of Tuberculosis and Lung Disease.