GONG Sheng 1,2 , JIANG Liangshuang 1 , WU Banggui 1 , ZHONG Ming 1 , JIA Shuang 1 , LI Xiao 1 , LIU Chao 1 , CHE Guowei 2
  • 1. Department of Thoracic Surgery, Chengdu Public Health and Medical Center, Chengdu, 610011, P.R.China;
  • 2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
CHE Guowei, Email: guowei_che@yahoo.com
Multidrug-resistant tuberculosis; Surgical intervention; Timing of surgery; Meta-analysis; Overview of systematic review
10.7507/1672-2531.201810009
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Objective To overview the systematic reviews on the timing of different surgical interventions for severe multidrug-resistant pulmonary tuberculosis patients.Methods PubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI databases were searched for systematic reviews about the timing of different surgical interventions for severe multidrug-resistant pulmonary tuberculosis patients from inception to December, 2018. Two reviewers independently screened literature, extracted data, evaluated the reporting and methodological qualities using the PRISMA checklist and the AMSTAR tool. After re-extraction of individual RCT data from included systematic reviews, meta-analysis was performed by Stata10.0 software.Results A total of 11 systematic reviews were included. The average methodological quality score was 8.13 in AMSTAR , the reporting quality score was from 19.5 to 25 in PRISMA. Re-performed meta-analysis showed that, the total success rate of operation was 93.3% (95%CI 92.9 to 93.8), the failure rate was 3.7% (95%CI 3.3 to 4.0), the mortality rate was 2.0% (95%CI 1.8 to 2.2), and the loss rate was 1.0% (95%CI 0.8 to 1.2). The cure rates of different surgical methods were all over 80%, among which single lobectomy (98.47%) and compound lobectomy (98.94%) had the higher cure rates than others. For the time of different surgical interventions, cure rate could be improved obviously in patients receiving surgery treatment after 1 months (OR=1.58, 95%CI 1.29 to 1.94, P=0.000 12), 1-8months (OR=1.66, 95%CI 1.30 to 2.12, P=0.000 05) and 9-24 months (OR=1.48, 95%CI 1.15 to 1.90, P=0.002) of anti-tuberculosis therapy compared with 0 month.There were significant differences between two groups.Conclusion Current evidence shows that operation is an effective way for severe multidrug-resistant pulmonary tuberculosis. Operative opportunity should be selected after 1-24 months of anti-tuberculosis drug treatment when the operation time depending on whether the tuberculosis has turned negative or not. Operative mode should be decided by the location and the scope of the lesion, which ensures the maximum excision of lesions and retention of lung function.

Citation： GONG Sheng, JIANG Liangshuang, WU Banggui, ZHONG Ming, JIA Shuang, LI Xiao, LIU Chao, CHE Guowei. Surgical intervention and timing of severe multidrug-resistant pulmonary tuberculosis: An overview of systematic reviews. Chinese Journal of Evidence-Based Medicine, 2019, 19(4): 464-470. doi: 10.7507/1672-2531.201810009 Copy

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