Pulmonary Resection for Extensively Drug Resistant Tuberculosis in Kwazulu-Natal, South Africa

Abstract

Extensively drug resistant tuberculosis (XDR-TB) has been reported in 58 countries around the world and has emerged as a major public health challenge. Our objective was to determine the impact of pulmonary resection on XDR-TB treatment outcomes in a resource-constrained setting. We conducted a retrospective case review of 11 patients with XDR-TB who were referred for pulmonary resection between January 2007 and June 2010 at a tertiary care referral hospital in South Africa. Two pneumonectomies and three upper lobectomies were performed. Occurrence of surgical complications and TB treatment outcome were assessed. No perioperative mortality or major morbidity was noted. All patients achieved sputum conversion, with 4 regarded as "cured." One patient defaulted on treatment, but subsequently returned and is regarded as a probable cure. We describe pulmonary resection for XDR-TB management in Africa. Although the initial cohort of XDR-TB patients from Tugela Ferry demonstrated nearly complete mortality, our results demonstrate the potential of adjuvant surgical methods in XDR-TB treatment. With appropriate chemotherapy and timely adjuvant surgery, patients with XDR-TB localized to lobe or lung may achieve a "cure" with low morbidity and mortality. Consequently, this approach may be the most cost effective treatment for patients suitable for lung resection.