Surgical aspects of pulmonary tuberculosis: an update

Abstract

Tuberculosis remains a major global medical challenge and concern. In the world's population of over 7.4 billion people, 8.6 million are estimated to be infected with Mycobacterium tuberculosis; another 2.2 billion have latent tuberculosis. There is an annual incidence of 16,000 new cases in the USA and 7-8 million new cases worldwide, of which 440,000 are multidrug-resistant or extensively multidrug-resistant, mainly in developing countries or emerging economies. According to the World Health Organization, the incidence of tuberculosis is 133 cases per 100,000 of the population; 3.3% new cases are drug resistant and 20% are already treated cases. Of the drug-resistant cases, 9.7% are extensively drug-resistant. The annual global mortality attributable to tuberculosis is over 1.3 million people. The association with HIV/AIDS in 430,000 people has compounded the global concern and challenge. This review presents the historical indications for surgical treatment of tuberculosis, reviews the current literature and clinical experience, and collates this into increased awareness and contemporary understanding of the indications and need for surgery in primary active tuberculosis, adjuvant surgical therapy for multidrug-resistant tuberculosis, and the complications of chronic tuberculosis sequelae or previous tuberculosis surgery.

Drug Regimen for Patients after a Pneumonectomy

“…Due to the advance in medical treatments, lung surgeries for TB have become less popular. However, it is estimated that ≈5% of TB patients may still require surgeries as an induction therapy or an adjuvant therapy in addition to medical treatments [93]. Pulmonary resections for TB are mainly performed for elective indications, such as in cases of multidrug-resistant tuberculosis (MDR-TB) or extensively drug-resistant tuberculosis (XDR-TB).…”

Tuberculosis: mother of thoracic surgery then and now, past and prospectives: a review

“…The protean behaviour of the tuberculosis and the differences of the geopolitical and economic influences on the disease make the answer to the question regarding the place of surgery in its management very difficult. The answer depends on where you are, what you have and who your patients are (99,100). The surgical attitude is defined by the drug sensitivity of the Koch bacillus, by the particular socioeconomic and cultural features of the patient cohort and by the capabilities of the relevant health care system.…”

“…The place of resective surgery is open for discussion as there are many divergent opinions. Language barriers accepted, it is obvious that there is a distinct way, led by the robust Russian (and ex-Soviet Union states) experience (106,107), of favouring resection, while the majority of publications from the Far East show a more restrained attitude (100,(108)(109)(110). There is an understandably highly conservative attitude in the high income low incidence countries, a stance recently challenged by mass migration and global tourism.…”

“…There is a relative consensus in the first group of indications for surgery (99,104). Failure of adequate medical therapy beyond 4-6 months of sputum-positive multidrug-MDR and XDR tuberculosis patients who have limited lesion(s) (usually a cavity) is a generally accepted indication for resection (100). Sputum/smear negative, but culture positive, patients with similar focal lesions are also candidates for surgery (118) if the radical removal of the involved lung is deemed possible and the patient's pulmonary reserve allows the operation.…”

Surgical treatment of multi-drug resistant pulmonary tuberculosis in children

“…Однак очевидно, що для подолання існуючої проблеми і запобігання подальшому розповсюдженню епідемії МРТБ у світі, застосування сучасних режимів хіміотерапії з використанням препаратів І-ІІ ряду та антибіотиків широкого спектра дії, активних щодо МБТ, є недостатнім [3][4][5]9]. За наявності незворотних морфологічних змін легеневої тканини та МРТБ хірургічні методи лікування є пріоритетними [1,7].…”