The Surgical Treatment of Cavitary and Non-Cavitary Tuberculosis in the Non-Infectious Patient

Abstract

Indications for resection in the non-infectious patient with a closed lesion have been presented. The results of non-resection in 136 patients with a relapse incidence of 14 per cent are contrasted to that of 9 per cent in 90 resected patients. In the sputum negative patient with a residual open lesion a comparison of 118 non-resected with 153 resected patients gave a relapse incidence of 43 per cent for the medical series extending through three post-treatment years and 9 per cent for the surgical group. At present 90 of 118 medical patients (76 per cent) are considered inactive while 133 of 155 surgical patients (87 per cent) are inactive. In the latter group (open negatives) the indications for surgery have included all patients who were satisfactory candidates. This policy has been supported by the relatively high relapse rate (43 per cent) of the non-resected patients and the recovery of viable tubercle bacilli in 38 per cent of the resected specimens. The problem of selection may well resolve itself if pulmonary surgery is reserved for those patients whose lesions have demonstrated their instability during the treatment period or thereafter.