ABORDAGEM CIRÚRGICA NA TUBERCULOSE

indicações atuais para ressecção pulmonar em casos refratários e manejo de complicações

Abstract

Tuberculosis (TB) remains a global public health challenge, particularly due to the increasing rates of antimicrobial drug resistance. Although medical treatment is the therapeutic cornerstone, thoracic surgery has re-emerged as a crucial adjunct in selected cases of refractory TB and its complications. This review examines current indications for pulmonary resection in drug-resistant TB, as well as the surgical management of associated complications, including massive hemoptysis, aspergilloma, and bronchopleural fistulas. Current evidence suggests that partial pulmonary resection (lobectomy or wedge resection), when combined with appropriate antimicrobial therapy, can significantly improve clinical outcomes in patients with multidrug-resistant (MDRTB) and extensively drug-resistant (XDR-TB) tuberculosis, particularly those at high risk of therapeutic failure. Furthermore, video-assisted thoracoscopic surgery (VATS) has demonstrated relevant advantages regarding postoperative recovery and the reduction of complications. Ultimately, the surgical management of TB and its sequelae requires a multidisciplinary approach, rigorous patient selection, and individualized operative strategies.