The role of surgery in the treatment of pulmonary TB and multidrug- and extensively drug-resistant TB

The global spread of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of M. tuberculosis have resulted in a resurgence of almost incurable and even fatal cases for which only a few therapeutic options are available. Surgery has been applied to improve treatment success rates in MDR-TB patients and a combined medical and surgical approach is increasingly being used to treat patients with M/XDR-TB. The effectiveness of surgery in the management of pulmonary TB (particularly MDR-TB) has not, however, been documented and evaluated, its role in the Tuberculosis Control Programme is not well-established and practices vary across the WHO European Region. The WHO Regional Office for Europe has decided, in collaboration with the Member States and other partners, to review existing practices and lessons learned and to document expert opinion based on the available evidence and consensus among the members of the European Task Force on the role of Surgery in MDR-TB. This consensus paper should not be considered as recommendations from WHO but as a document of expert opinion based on current evidence, which presents indications and contraindications for surgical treatment of pulmonary TB and M/XDR-TB, the conditions for and timing of surgery, types of operation, and preoperative and postoperative management.