Surgical approach in multi- and extensively drug-resistant tuberculosis: resection and thoracomioplasty

Objective: To define a surgical approach in treatment of multi- and extensively drug-resistant tuberculosis. Design: The article described a retrospective analysis of surgical treatment of 246 multi- and extensively drug-resistant tuberculosis patients who were divided into 3 groups: 152 multi-drug-resistant tuberculosis patients operated during the chemotherapy with second-line anti-tuberculosis drugs, 65 multi-drug-resistant tuberculosis patients operated during the chemotherapy with first-line anti-tuberculosis drugs, and 29 extensively drug-resistant tuberculosis patients who were treated with second- and third-line drugs. Results: Resection methods of treatment produce positive results in 98.0% of multi-drug-resistant tuberculosis cases when rational chemotherapy is available. In case of extensively drug resistance a choice of surgical intervention depends on a degree of lung involvement, clinical form of disease. With restrictive lung involvement it is possible to use resection methods and with extensive lung involvement it is preferable to apply collapse surgical methods of treatment. Conclusion: A surgical approach in treatment of multi- and extensively drug-resistant tuberculosis patients depends on a spectrum of anti-tuberculosis drug resistance, degree of involvement, and clinical form of disease.