Role of Surgery in DR-TB Treatment

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.

Resources​

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
• Consolidated Guidelines on Tuberculosis: Module 4 - Treatment: Drug-resistant TB Treatment, 2020.  
• Technical and Operational Guidelines for TB In India, 2016.

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