Do specialist pulmonologists appropriately utilise thoracic surgery for drug-resistant pulmonary tuberculosis? A survey.

G Alexander, R Perumal



Adjuvant lung resection in patients with drug-resistant tuberculosis (DR-TB) is not only cheaper than a 2 month course of drug therapy for multi-drug resistant TB (MDR-TB) but more importantly has a higher cure rate than medical therapy alone. Cure rates for selected patients with MDR-TB, treated with adjuvant lung resection is about 90%. With the more severe forms of DR-TB, surgical cure rates in selected patients appear to remain the same whilst cure rates decrease with medical therapy alone. In addition, adjuvant lung resection for DR-TB in selected patients with HIV co-infection also do not appear to have a higher complication rate.



To determine whether specialist pulmonologists in South Africa appropriately utilise thoracic surgical intervention for DR-TB.



A cross-sectional survey of all pulmonologists belonging to the South Africa Thoracic Society was conducted. The study tool was a pre-designed, anonymous questionnaire which included 17 close-ended questions pertaining to knowledge of the role of cardiothoracic surgery in the management of DR-TB.



Twenty-five pulmonologists responded to the survey. The majority of respondents did not know the indications for adjuvant lung surgery in the setting of drug-resistant tuberculosis, and would have altered their referral behaviour had they been aware of these indications.




The uncertainty regarding optimal utilisation of adjuvant lung resection for patients with DR-TB amongst pulmonologists suggest the necessity of the development of local guidelines and doctor education relevant to the management of these patients. These strategies should include the participation of both the pulmonologist and cardiothoracic surgeon.

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