Surgery as an adjunctive treatment for multidrug-resistant tuberculosis

An individual patient data metaanalysis

Gregory J. Fox, Carole D. Mitnick, Andrea Benedetti, Edward D. Chan, Mercedes Becerra, Chen Yuan Chiang, Salmaan Keshavjee, Won Jung Koh, Yuji Shiraishi, Piret Viiklepp, Jae Joon Yim, Geoffrey Pasvol, Jerome Robert, Tae Sun Shim, Sonya S. Shin, Dick Menzies

Research output: Contribution to journalArticle

27 Citations (Scopus)

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; I2R, 11.8%), but pneumonectomy was not (aOR, 1.1; 95% CI,. 6-2.3; I2R, 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; I2R, 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.

Original languageEnglish
Pages (from-to)887-895
Number of pages9
JournalClinical Infectious Diseases
Volume62
Issue number7
DOIs
Publication statusPublished - Apr 1 2016

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Multidrug-Resistant Tuberculosis
Lung
Pneumonectomy
Therapeutics
Odds Ratio
Confidence Intervals
Poisons
Patient Selection
Cohort Studies
Recurrence

Keywords

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

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Surgery as an adjunctive treatment for multidrug-resistant tuberculosis : An individual patient data metaanalysis. / Fox, Gregory J.; Mitnick, Carole D.; Benedetti, Andrea; Chan, Edward D.; Becerra, Mercedes; Chiang, Chen Yuan; Keshavjee, Salmaan; Koh, Won Jung; Shiraishi, Yuji; Viiklepp, Piret; Yim, Jae Joon; Pasvol, Geoffrey; Robert, Jerome; Shim, Tae Sun; Shin, Sonya S.; Menzies, Dick.

In: Clinical Infectious Diseases, Vol. 62, No. 7, 01.04.2016, p. 887-895.

Research output: Contribution to journalArticle

Fox, GJ, Mitnick, CD, Benedetti, A, Chan, ED, Becerra, M, Chiang, CY, Keshavjee, S, Koh, WJ, Shiraishi, Y, Viiklepp, P, Yim, JJ, Pasvol, G, Robert, J, Shim, TS, Shin, SS & Menzies, D 2016, 'Surgery as an adjunctive treatment for multidrug-resistant tuberculosis: An individual patient data metaanalysis', Clinical Infectious Diseases, vol. 62, no. 7, pp. 887-895. https://doi.org/10.1093/cid/ciw002
Fox, Gregory J. ; Mitnick, Carole D. ; Benedetti, Andrea ; Chan, Edward D. ; Becerra, Mercedes ; Chiang, Chen Yuan ; Keshavjee, Salmaan ; Koh, Won Jung ; Shiraishi, Yuji ; Viiklepp, Piret ; Yim, Jae Joon ; Pasvol, Geoffrey ; Robert, Jerome ; Shim, Tae Sun ; Shin, Sonya S. ; Menzies, Dick. / Surgery as an adjunctive treatment for multidrug-resistant tuberculosis : An individual patient data metaanalysis. In: Clinical Infectious Diseases. 2016 ; Vol. 62, No. 7. pp. 887-895.
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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; I2R, 11.8{\%}), but pneumonectomy was not (aOR, 1.1; 95{\%} CI,. 6-2.3; I2R, 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; I2R, 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.",
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