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In Drug-resistant TB (DR-TB) patients with localized disease, surgery, as an adjunct to chemotherapy, can improve outcomes; provided that skilled thoracic surgeons and excellent postoperative care is available.​

 

A patient with a unilateral resectable disease may be considered for surgery if there is: ​

  • Absence of clinical or bacteriological response to chemotherapy despite 6 to 9 months of treatment with effective anti-TB drugs​
  • High risk of treatment failure or relapse due to a high degree of resistance or extensive parenchymal involvement​
  • Morbid complications of parenchymal disease, e.g., hemoptysis, bronchiectasis, broncho-pleural fistula or empyema​
  • Relapse after completion of anti-TB treatment​

 

The World Health Organization (WHO) has recommended surgical procedures like wedge resections or lobectomy in patients with localized lesions. 

 

If a surgical option is under consideration, at least six to nine months of chemotherapy is recommended prior to surgery to ensure culture conversion.​​

 

States and districts should identify and establish linkages with institutions that have thoracic surgical facilities. This is to provide surgical options after thoroughly evaluating and reviewing a patient who requires such surgical intervention.

 

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