[Adjuvant surgical resection for multidrug-resistant tuberculosis: A review]

Rev Mal Respir. 2014 Jun;31(6):511-24. doi: 10.1016/j.rmr.2014.01.014. Epub 2014 Apr 18.
[Article in French]


Introduction: The frequency of multi and extensively drug resistant pulmonary tuberculosis (MDR/XDR-TB) is increasing worldwide, with major issues related to treatment modalities and outcome. In this setting, the exact benefits associated with surgical resection are still unknown.

Methods: We performed a literature review to determine the indications, morbidity, mortality and bacteriological success associated with the surgical management of MDR/XDR-TB patients.

Results: Altogether, 177 publications dealing with surgical resection and MDR/XDR-TB have been analyzed, including 35 surgical series and 24 cohort studies summarized in one meta-analysis. The surgical series reported success rates from 47% to 100%, complication rates from 0 to 29%, and mortality rates from 0 to 8%. The published meta-analysis reported a statistically significant association between surgical resection and treatment success (OR 2.24, IC95% 1.68-2.97). However, all these studies were associated with selection bias. International consensual guidelines included a multidisciplinary assessment in a reference centre, a personalized and prolonged antibiotic treatment and a medico-surgical discussion on a case-to-case basis.

Perspectives: These guidelines are now applied for the management of patients with MDR/XDR-TB in our centre. Further studies are required to avoid further increase in the burden of MDR/XDR-TB and to establish the optimal timing of medical and surgical treatments.

Keywords: Chirurgie thoracique; Extensively drug resistant tuberculosis; MDR-TB; Multidrug-resistant tuberculosis; Thoracic surgery; Tuberculose multirésistante; Tuberculose ultrarésistante; XDR-TB.

Publication types

  • Review

MeSH terms

  • Antitubercular Agents / therapeutic use
  • Combined Modality Therapy
  • Extensively Drug-Resistant Tuberculosis / drug therapy
  • Extensively Drug-Resistant Tuberculosis / epidemiology
  • Extensively Drug-Resistant Tuberculosis / surgery*
  • Humans
  • Mycobacterium tuberculosis
  • Thoracic Surgical Procedures* / methods
  • Thoracic Surgical Procedures* / statistics & numerical data
  • Treatment Outcome
  • Tuberculosis, Multidrug-Resistant / drug therapy
  • Tuberculosis, Multidrug-Resistant / epidemiology
  • Tuberculosis, Multidrug-Resistant / surgery*


  • Antitubercular Agents