American Thoracic Society Journal news tips for May 2004 (second issue)

05/17/04

Surgery provides very favorable outcome for long-term multidrug-resistant tuberculosis patients

Among a group of 205 patients who had multidrug resistant tuberculosis (TB) for an average of over 4 years, the 130 persons who underwent surgical resection to remove diseased lung tissue had nearly a fivefold increase in favorable outcome, according to a study published in the second issue for May 2004 of the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine. The study's researchers, who reviewed the records of patients discharged from the National Jewish Medical and Research Center, Denver, Colorado, between January 1, 1984, and December 31, 1998, saw a 75 percent long-term success rate and only a 12 percent death rate in this population. These results were in direct contrast to those from a 1973 to 1983 study of multidrug resistant TB patients treated at the same institution that showed a 56 percent long-term success rate and a mortality rate of 37 percent. The National Jewish Medical and Research Center specializes in the treatment of multidrug resistant TB. The investigators said that surgical resection of destroyed lung tissue was aggressively considered for patients who, from their prior experience, were deemed likely to fail medical treatment based on their resistance patterns and/or extent of disease. According to the researchers, among the 162 patients for whom there was sufficient data to evaluate outcomes, 137 (85 percent) converted their sputum cultures to negative values, but 25 (15 percent) failed to convert.

In an editorial in the same issue about the study, author David E. Griffith, M.D., of the University of Texas Health Center, Tyler, Texas, said that there had been an important shift in TB epidemiology in the U.S., with 50 percent of the new cases and approximately 69 percent of the multidrug-resistant TB cases diagnosed in persons born outside the U.S. They had acquired their disease before they entered the country. He called a contribution by surgery to the treatment of multidrug resistant TB "not unexpected,' but, as the most important factor in treatment related to favorable outcome was "surprising." He pointed out that the surgeons at the National Jewish Medical and Research Center were unquestionably the most experienced mycobacterial lung disease surgeons in the U.S. Since widely accepted preoperative criteria are not available to choose the best patients to benefit from surgery, these surgeons had the experience to assess very carefully the risk/benefit balance for these individual patients. The experience factor becomes doubly important when persons realize that mycobacterial lung disease surgery "can be associated with significant and unpredictable surgical complications."

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