Surgical Management of Drug-Resistant Tuberculosis

The resurgence of surgery as an adjunct to chemotherapy has reshaped the management of drug-resistant tuberculosis. In patients with multidrug-resistant and extensively drug-resistant disease who fail to respond to prolonged medical regimens, targeted resection of affected lung tissue can reduce bacillary load, alleviate complications and improve overall cure rates. Indications for surgical intervention include persistent cavitation, severe haemoptysis, destroyed lobe or lung and life-threatening complications such as bronchopleural fistula. Preoperative assessment centres on spirometric indices (including FEV1), diffusion capacity (DLCO) and nutritional status. Procedures range from anatomical segmentectomy and lobectomy to pneumonectomy, often performed via video-assisted thoracoscopic surgery to minimise trauma. Outcomes have improved with careful patient selection and perioperative care, yielding higher treatment completion rates and reduced relapse. However, risks of postoperative complications—bleeding, empyema and residual respiratory impairment—necessitate multidisciplinary planning. Globally, the integration of surgical and medical approaches offers a powerful tool for resource-limited settings burdened by drug-resistant forms of tuberculosis.

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Surgical Management of Drug-Resistant Tuberculosis publication trend

The graph below shows the total number of articles in surgical management of drug-resistant tuberculosis across all publications each year (not limited to Nature Index journals).

Technical terms

Multidrug-resistant tuberculosis (MDR-TB): Tuberculosis resistant to at least isoniazid and rifampicin, necessitating second-line drugs.

Extensively drug-resistant tuberculosis (XDR-TB): MDR-TB with additional resistance to fluoroquinolones and one second-line injectable agent.

Pneumonectomy: Surgical removal of an entire lung lobe to eradicate diseased tissue.

Video-assisted thoracoscopic surgery (VATS): Minimally invasive technique using small incisions and a thoracoscope to perform lung resections.

Forced expiratory volume in one second (FEV1): Volume of air expelled in the first second of a forced exhalation, used to assess pulmonary reserve.

Diffusing capacity of the lung for carbon monoxide (DLCO): Measure of gas transfer efficiency across the alveolar–capillary membrane.

Bronchopleural fistula: Abnormal communication between the bronchial tree and pleural space, often leading to persistent air leak.

References

1. The effect of surgery on the outcome of treatment for multidrug-resistant tuberculosis: a systematic review and meta-analysis. BMC Infectious Diseases (2016).
2. The Efficacy and Safety of Surgical Treatment for Patients With Tuberculosis Destroyed Lung With or Without Chronic Pulmonary Aspergillosis. World Journal of Surgery (2021).
3. Incidence and risk factors of postoperative complications in patients with tuberculosis-destroyed lung. BMC Pulmonary Medicine (2021).
4. The Role of Video-Assisted Thoracoscopic Therapeutic Resection for Medically Failed Pulmonary Tuberculosis. Medicine (2016).
5. Long-term follow-up of tuberculosis-destroyed lung patients after surgical treatment. BMC Pulmonary Medicine (2022).
6. Value of preoperative evaluation of FEV1 in patients with destroyed lung undergoing pneumonectomy - a 20-year real-world study. BMC Pulmonary Medicine (2024).