The Role of Surgery in Tuberculosis Management: Indications and Contraindications

Abstract

A significant progress has been achieved in the treatment of drug-susceptible tuberculosis (TB). However, the global spread of multidrug-resistant TB (MDR-TB) and externsively drug-resistant TB (XDR-TB) has resulted in a resurgence of almost incurable and even fatal cases and surgery is being re-evaluated as one of the treatment options for TB and MDR/XDR-TB. Cavitary MDR/XDR-TB with anti-TB chemotherapy failure is nowadays the main indication for surgery. The current indications for surgery in pulmonary TB can be divided into three groups: emergency, urgent and elective. Surgery in TB and MDR/XDR-TB should be considered when the disease is sufficiently localized to allow surgery, the remaining lung tissue around the resection margins is estimated to be free of TB, and the patient’s surgical risk level is acceptable, i.e. with sufficient pulmonary reserve to tolerate the resection. In many cases after the removal of the irreversibly damaged part of lung functional respiratory indicators have been improved or become normal. The principal types of operation to treat TB today are lung resections of different sizes. Pulmonary resection today combined with appropriate pre- and post-operative anti-TB chemotherapy for TB and MDR/XDR-TB enables treatment success rates to be achieved even in difficult clinical circumstances up to 88–92% of cases.