CHEMOTHERAPY IN RESECTION FOR PULMONARY TUBERCULOSIS - PROBLEMS OF EXTENSIVE DISEASE AND DRUG-RESISTANT ORGANISMS

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Abstract
In a period of nearly 5 years, 358 patients were subjected to pulmonary resection. A total of 112 patients had extensive resections. A total of 110 patients (including 52 of the patients subjected to extensive resection) had strains of tubercle bacilli resistant to the major anti-tuberculous drugs, streptomycin and isoniazid, and/or infectious sputum at the time of resection. Chemotherapy was individualized in order to provide maximal chemotherapeutic control. A total of 98 patients received one or more of the so-called minor antituberculous agents, i.e., viomycin, pyrazinamide, and cycloserine, the choice of agents and the timing of their administration depending on the kind and degree of bacterial resistance in vitro and the therapeutic goal to be achieved. Surgical mortality was 1.7%; tuberculous complications, 5.4%. Approximately 5 years after the first resection in the series, 88.2% of the 340 patients whose status was known had inactive pulmonary tuberculosis. Only 3 of the 26 deaths were caused by tuberculous infection. Including patients who were left with active or active-improved disease, as well as those who died of their infection, a total of 17 patients (5% of all patients whose status was known) were considered to be therapeutic failures. In respect to tuberculous complications, problems of chemotherapy proved to be far more important than the extent of resection. The incidence of complications was no greater among the patients subjected to pneumonectomy than among those who had less extensive resections. On the other hand, 16.5% of the patients who had problems of chemotherapy suffered tuberculous complications as compared with 1.2% of the patients who did not have such problems as far as was known. Late as well as early results of pulmonary resection varied inversely with the severity of the patients'' chemotherapeutic problems. Yet, even in the groups of patients with the most serious problems, the great majority were brought to a status of inactivity. The degree of success attained in resections for pulmonary tuberculosis varies directly with the chemotherapeutic control of the patients'' disease. By the judicious use of all available chemotherapeutic agents, many patients who have extensive disease and those who have organisms resistant to streptomycin and isopiazid can be treated successfully by resectional surgery.

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