The Role of Surgical Interventions for Pulmonary TB: What Is the Role of Surgical Intervention in Pulmonary TB?

Abstract

AbstractPrior to the induction of effective chemotherapy, the treatment for pulmonary TB was limited and mainly surgical. The development of anti-TB drugs has rendered TB a curable disease via chemotherapy, and the role of surgery for TB has diminished. However, in the 1990s, multidrug-resistant pulmonary tuberculosis (MDR-TB) and extensive drug-resistant tuberculosis (XDR-TB) emerged, and surgical treatment became a necessary intervention once again.The current role of surgical treatment for pulmonary TB is to increase the treatment success rate. Surgery is indicated for drug-resistant pulmonary TB that is difficult to treat with chemotherapy alone. For patients who are persistently sputa-positive despite adequate chemotherapy, the goal of surgery is to convert the patient to sputa-negative and improve the effects of medical treatment by removing cavitary lesions and damaged lung tissues that contain a large number of TB bacilli. Surgery should also be considered for patients with large residual cavities who have a high risk of relapse, even if sputum cultures become negative after chemotherapy.Surgical treatment for pulmonary TB consists mainly of anatomical lung resection and requires advanced surgical skills, as the dissection of adhesions on the chest wall and the isolation of hilar structures are required. In addition, various techniques for preventing bronchial stump fistulas and chest space complications are required; therefore, this surgery should be conducted by experienced surgical teams in specialized facilities. Surgery is a multidisciplinary strategy for the treatment of drug-resistant TB, and cooperation between physicians and surgeons is essential to attain the best outcomes in pre- and postoperative management and chemotherapy.Compared with chemotherapy alone for MDR-TB and XDR-TB, adjunctive surgery combined with chemotherapy has been reported to have a higher treatment success rate. Although the significance of surgical treatment for drug-resistant TB has not yet been clearly established, several published reports have demonstrated the effectiveness of surgical interventions for patients with pulmonary TB.KeywordsSurgical pulmonary resectionDrug-resistant TB