The long-term results of surgical treatment of destructive pulmonary tuberculosis in the Russian F ederation and ways of its’ improvement

With the annual increase in the prevalence of multidrug-resistant (MDR) pathogen, the effectiveness of etiotropic chemotherapy of tuberculosis is decreasing; the demand for surgical treatment, the use of which remains limited in the world and in the Russian Federation, is increasing. The aim of the study is to evaluate the effectiveness of the strategy of treatment of first detected destructive pulmonary tuberculosis based on early and wide application of surgical treatment, including minimally invasive techniques. Materials and methods . A retrospective cohort multicenter study included patients of tuberculosis institutions in 51 regions of the Russian Federation, analyzed the performance of phthisiosurgical departments for the period 2007–2016. The long-term results of treatment were evaluated in 1090 patients operated for MDR/XDR tuberculosis (Group 1) and in 888 patients who refused surgery (Group 2). Results . In Penza region, 92.8% of patients were abacilliated one year after application of the developed strategy, lethality decreased 3 times compared to the results of treatment in the previous 2 years; in 3 years clinical cure was registered in 94% of operated patients. During 4 years of active surgery in Chuvashia the contingent of patients with fibrotic cavernous tuberculosis was reduced 2.3 times, in Tambov region “bacillary core” in the region was reduced 3.6 times. Effective course of treatment was noted in 92,6% of patients of group 1 (operated) and only in 17,1% of patients of group 2 (refused surgery), р < 0,001. Clinical cure in 3 years was achieved in 85.7% of group 1 patients and only 5.2% of group 2 patients (р < 0,001). Conclusion . Wide application of surgical treatment and collapse therapy is a prerequisite for achieving the target indicators of treatment efficiency in tuberculosis patients.