Where is lung resection surgery for DR-TB being performed?

By Dylan Tierney Moderator Emeritus | 11 Nov, 2016

Many patients with DR-TB would benefit from lung resection surgery but do not have access to this type of sophisticated surgical management. First, there is a shortage of experienced thoracic surgeons who can perform the operation. There is also a lack of infrastructure that is necessary to make sure the procedure is performed according to accepted standards of care, including fully functional operating rooms and surgical intensive care units.

I’m interesting in creating a list of locations (surgeons, hospitals, countries) where lung resection surgery for DR-TB is currently being performed. My hope is that this list can then be used as a reference when working to increase access to high quality surgery worldwide.

Community members, please respond with any information that might be helpful in compiling this list.

Replies

 

Tamirirashe Mahwire Replied at 2:48 PM, 11 Nov 2016

I know Inkosi Albert Luthuli Hospital and King Dinizulu have a program . Kindly review attached documents of DR TB patients who were surgically managed
regards

Attached resources:

Urvashi Singh Replied at 7:39 PM, 11 Nov 2016

Dr Dewan at National Institute of TB and Respiratory Diseases,New
Delhi,India performs such surgeries.

Dr Lalit Kumar Anande Replied at 8:16 PM, 11 Nov 2016

Hi,

Supra Major Thoracic Surgeries are being regularly carried out with a
fantastic success rate by eminent highly experienced senior Surgeons at
Group of TB Hospitals, Sewri, Mumbai, Maharashtra India.

Approximately 5 to10 surgeries are done every month. There are many
indications for such surgeries to be carried out in DRTB patients which
fetches good results.

Dr Shanta Ghatak Replied at 11:14 PM, 11 Nov 2016

What about TB IC

Sent from Shanta's iPad

Sonam Solanki Replied at 4:05 AM, 12 Nov 2016

Lung resection surgery is regularly being performed in Kem hospital, Pune. Team of pulmonologists is also available to look into the peri operative issues. Vats and open thoracotomy both are performed.

Igor Kalabukha Replied at 5:27 AM, 14 Nov 2016

The National Institute of Tuberculosis and Pulmonology of the National Academy of Medical Sciences of Ukraine has more than 60 years of experience in the surgical treatment of patients with pulmonary tuberculosis, including drug-resistant tuberculosis.

Attached resource:

Sergo Vashakidze Replied at 5:24 AM, 16 Nov 2016

In the indicated cases resection surgery  is an important part of the complex  treatment of patients with pulmonary tuberculosis, including  MDR/.XDR TBSuch operations successfully are  carried out at the National Center for Tuberculosis and Lung Diseases of Georgia (over 100 operations per year)http://tbgeo.ge/

Dylan Tierney Moderator Emeritus Replied at 2:44 PM, 17 Nov 2016

Based on the responses, it looks like there are strong and well-established programs for the surgical management of DR-TB in South Africa and India.

It also seems like surgeries are performed regularly in former Soviet states like Ukraine and Georgia. It would be interesting to hear about other countries in this group, like the Russian Federation and Kazakhstan, which combine to notify about 20,000 cases of MDR-TB annually.

There are also other high-burden MDR-TB countries in Asia that have not been mentioned (e.g., China, Philippines, Myanmar, and Vietnam). Please let me know if there are resection surgeries for DR-TB taking place in these countries as well.

anita kansal Replied at 3:58 AM, 18 Nov 2016

Dear Fellows,
These surgeries are being performed at surgical Department, NITRD, New Delhi, India.

Igor Kalabukha Replied at 8:38 AM, 18 Nov 2016

There are many centers of TB surgery In Russia. Before the war we had a very good relationship with TB surgeons from Russia:
Research Institute Phthisiopulmonology Moscow Medical Academy (Moscow, prof. D. Giller) http://www.mma.ru/science/nii/phthisio/
Central Research Institute of Tuberculosis (Moscow, prof. M. Bagirov) http://critub.ru/surgery-department/
St. Petersburg Research Institute Phthisiopulmonology (St. Petersburg, prof. P. Yablonsky) http://www.spbniif.ru/
Research Institute - Regional Clinical Hospital №1 (Krasnodar, Prof. V. Porkhanov) Http://kkbo.ru/
Ural Research Institute Phthisiopulmonology (Ekaterinburg, prof. I. Motus) http://urniif.ru/clinic/surgery/lho/
Novosibirsk Research TB Institute (Novosibirsk, prof. V. Krasnov) http://nsk-niit.ru/ru/
Scientific and Practical Center "Phthisiology" (Yakutsk, prof. A. Kravchenko) http://ftiziatria.ykt.ru/

Petros Isaakidis Replied at 11:53 AM, 18 Nov 2016

Dear Dylan,
Just to add to Dr Anande's comment; in Mumbai, and India in general, there's a lot of experience and a great potential. We have made an effort to look at available surgical data from the largest public TB Hospital in India (Group of TB Hospitals, Sewri, Mumbai, where Dr Anande has been working) as well as a large private facility in Mumbai performing surgery for TB and DR-TB.
I attach here the published report.

The data (surprisingly limited) show satisfactory surgical outcomes. They also show , however, that eligibility for surgery was established late, culture and DST were not systematically offered, the interval between admission and surgery was long and TB outcomes were not known. Documentation of the outcome of anti-tuberculosis treatment was generally absent in the surgical register, and there was no means of systematically retrieving this information from any source.
I guess this might be the case in several other countries.
A possible solution could be the systematic use of a unique patient identifier linking surgery data with TB programme data.

Petros

Attached resource:

Dylan Tierney Moderator Emeritus Replied at 3:18 PM, 18 Nov 2016

Thanks, Petros. Your post reminds me that we should be using a cascade of care model when we think about access to quality surgical services for DR-TB.

There are patients with surgical DR-TB disease that can’t even get to facility that is performing the operation, which is the first step in the cascade. There are also patients that are not receiving the standard of care (e.g., lack of culture and DST to guide management) if they are lucky enough to find that surgical care. Finally, the long recovery period is fraught with setbacks. I wonder how many patients that get operated on are getting the post op care that we would expect in Boston.

So, while the surgical outcome is really the only hard endpoint that matters, it seems like there are other core indicators of quality TB surgery along the cascade that might be important to define, formalize and begin reporting on as the field moves forward in trying to increase access to this critical intervention.

Sergo Vashakidze Replied at 3:23 AM, 19 Nov 2016

Study long-term results of surgical treatment of patients with  resistant tuberculosis (as well as after antituberculous drug therapy) is very important and interesting. We published an article on the surgical treatment of 80 patients with MDR / XDR TB : Ann Thorac Surg. Jun 2013; 95 (6): 1892-1898."Favorable Outcomes for Multi- and Extensively Drug Resistant Tuberculosis Patients Undergoing Surgery " with a mean follow-up time  after surgery  379 days. .Currently  we are finishing a comparative study of long-term results (2 years or more after removal from TB register) of medical and surgical treatment of patients with MDR/XDR TB(406 patients in total).

Masoud Dara, MD Moderator Replied at 5:09 AM, 20 Nov 2016

Thank you Dylan and colleagues for the query and discussion on a very important area. Back in 2014, with the inputs of a task force including practicing surgeons and other relevant experts, we developed a consensus document on the role of surgery in the treatment of pulmonary TB and M/XDR-TB. You may find the document below and on the enclosed link.

All the best,
Masoud

Attached resources:

Dirk von Delft Replied at 8:23 PM, 20 Nov 2016

Hello Dylan
I am from South Africa and I will try an compile a more extensive list of hospitals where TB surgery could be performed. I say "Could be" because currently the situation is that there is actually very little surgery being done for TB and surgeons doing dedicated thoracic surgery, are far and few between. However, there are many hospitals that could provide well equipped OR's and ICU's and radiology for this sort of service.

Dirk

egh Eduardo Gotuzzo Replied at 9:27 PM, 20 Nov 2016

dear DYLAN
In Peru one special group in Hospital Hipolito Unanue of Lima have the
expereince as national center and the results when you made a strong and
very carefull criteria the results are very good becuase you can reduce
thesputum positive and improve the clincal outcomes with low
mortality.(below 3%)

usually the NMDR need tio be treated minimal 6 months with positive sputm
at month 6 and cavity well definie etc
we stemite this option is very useful for these patitents and for the
public health system
with important biosafety procedure and well trining to anestesiology,nurses
etc the surgeon can conducted these cases and avoid disemination in
operation room
regards
eduardo Gotuzzo

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Dylan Tierney Moderator Emeritus Replied at 1:24 PM, 21 Nov 2016

Dirk von Delft makes an important point: there may be theoretical capacity to manage DR-TB surgically but that capacity isn’t always accessible in the real world.

I wonder how much of this gulf between theoretical capacity and real world accessibility is due to a lack of surgeons who are willing to perform the procedure. They face many potential disincentives. Lobectomy is technically difficult and requires extensive training. Good surgical outcomes are far from guaranteed in these tenuous patients. Finally, there is a risk for transmission of DR-TB from patient to healthcare worker in the operating room.

Dirk, please let us know what you think are the biggest reasons for the gap between having adequate surgical facilities and the few patients actually undergoing the operation for DR-TB in South Africa.

JAMAL AHMAD Replied at 1:43 PM, 21 Nov 2016

Sent from my Samsung Galaxy smartphone.

Ravindra Dewan Replied at 2:06 AM, 12 Oct 2017

I am Ravindra Dewan and I head the Department of Thoracic Surgery at the National Institute of Tuberculosis and Respiratory Diseases, New Delhi. About 500 major thoracic surgical procedures per year are carried out in the Department. The cases usually include surgery for complications of pulmonary tuberculosis including DR-TB and carcinoma lung in addition to other chest conditions. All types of major chest surgery like lung resections, decortication, thoracoplasty, video-assisted thoracic surgery and tracheal surgery are being done. Latest techniques like VATS, surgical staplers, harmonic scalpel, digital portable suction machine and tissue patch etc. are employed to obtain the best possible result.The experience here includes some of the most challenging lung resections. As most of the cardio-thoracic surgical centers in the country are engaged almost exclusively in cardiac surgery, facilities for general thoracic surgery are scarce. It has a wide referral base and the results are also comparable to international standards.

Attached resources:

Igor Kalabukha Replied at 4:15 AM, 13 Oct 2017

I already wrote earlier about my colleagues who are engaged in TB surgery
in Russia. However, I forgot to point out that tuberculosis surgery is also
present in Ukraine. In our institute of phthisiology and pulmonology (
www.ifp.kiev.ua) there are two surgical departments. We annually perform
more than 600 diagnostic and treatment operations in patients with
tuberculosis. Most often we perform resections of lungs of different
volume. Also, but less often, we use thoracoplasty. In addition, we have a
lot of experience in performing videothoracoscopy to establish a diagnosis
for pleural effusive syndrome, pathology of intrathoracic lymph nodes,
pulmonary dissemination. There are active surgical departments in
anti-tuberculosis facilities in the Dnieper, Lviv, Kherson and other
regional centers of Ukraine.

2017-10-12 9:16 GMT+03:00 Ravindra Dewan via GHDonline <>:

Dirk von Delft Replied at 6:26 AM, 13 Oct 2017

Good Afternoon Dr Dewan.

Thank you for sharing your experience with TB related thoracic surgery and
the attached resources.
It is very insightful.
I would like to e-mail you directly regarding TB related chest surgery in
children and adolescents if that is OK with you.