Adjuvant surgical resection for multidrug-resistant tuberculosis: A review

作者：Mordant P; Henry B; Morel S; Robert J; Veziris N; Le Du D; Frechet Jachym M; Similowski T; Caumes E; Riquet M; Le Pimpec Barthes F^*

来源：Revue des Maladies Respiratoires, 2014, 31(6): 511-524.

DOI：10.1016/j.rmr.2014.01.014

• Multidrug-resistant tuberculosis
• Extensively drug resistant tuberculosis
• MDR-TB
• XDR-TB
• Thoracic surgery

Introduction. - The frequency of multi and extensively drug resistant pulmonary tuberculosis (MDR/XDR-TB) is increasing worldwide, with major issues related to treatment modalities and outcome. In this setting, the exact benefits associated with surgical resection are still unknown.
Methods. - We performed a literature review to determine the indications, morbidity, mortality and bacteriological success associated with the surgical management of MDR/XDR-TB patients.
Results. - Altogether, 177 publications dealing with surgical resection and MDR/XDR-TB have been analyzed, including 35 surgical series and 24 cohort studies summarized in one meta-analysis. The surgical series reported success rates from 47% to 100%, complication rates from 0 to 29%, and -mortality rates from 0 to 8%. The published meta-analysis reported a statistically significant association between surgical resection and treatment success (OR 2.24, IC95% 1.68-2.97). However, all these studies were associated with selection bias. International consensual guidelines included a multidisciplinary assessment in a reference centre, a personalized and prolonged antibiotic treatment and a medico-surgical discussion on a case-to-case basis.
Perspectives. - These guidelines are now applied for the management of patients with MDR/XDR-TB in our centre. Further studies are required to avoid further increase in the burden of MDR/XDR-TB and to establish the optimal timing of medical and surgical treatments.

• 出版日期2014-6