Abstract
The aim of the study. To assess the long-term outcomes of surgical and conservative treatment for multidrug-resistant (MDR) and extensively drug-resistant (XDR) destructive pulmonary tuberculosis. Material and methods. We analyzed the long-term results of MDR/XDR surgery for destructive pulmonary tuberculosis in 1,140 patients from the Departments of Phthisiopulmonology and Thoracic Surgery at Sechenov University and the Rostov Regional TB Dispensary between 2011 and 2023. We also analyzed the outcomes of 2,575 patients from the Rostov region, who received conservative treatment between 2004 and 2020, with an ineffectively completed primary course of chemotherapy, or who had relapsed after an effective course. Results. The full effect of treatment after one year was achieved in 99.5% of patients who underwent surgery, compared to 5.3% of those who did not undergo surgery (an 18.8-fold difference). After five years, the full effect was seen in 97.7% of operated patients and only 3.2% of non-operated patients (a 30.5-fold difference). Death due to tuberculosis during the 12-year follow-up period was noted in 0.8% of radically operated and conditionally operated patients (9 cases), compared to 72.4% of non-operated patients (643 cases; a 90.5-fold increase). The 5-year survival rate after surgery was 95.3%, which was 3.3 times higher than that of the group who refused surgery (29%). Conclusions. When comparing the outcomes of treatment for patients who underwent radical and conditional surgery with a group of patients who declined surgery (subgroup 2a), it has been demonstrated that the overall effectiveness after one year and five years was greater in operated patients than in those who declined surgery. Tuberculosis mortality in operated patients was 90.5 times lower (0.8% compared to 72.4%). The 5-year survival rate of operated patients was 3.3 times greater (95.3% compared to 29%).