Retrospective study of clinical and lesion characteristics of patients undergoing surgical treatment for Pulmonary Tuberculosis in Georgia

- Therapeutical surgery is still currently used for pulmonary TB in Georgia, both for DS and for MDR/XDR-TB; one of the main indications for it is the presence of lesions in radiological assays.
- 70% of patients were men, and most of operated lesions showed the presence of fresh necrosis in spite of long-termed treatment with first or second line drugs.
- There are statistically significant differences in the type of necrosis and culture conversion according to gender and drug sensitivity of the responsible strains.
- A non despricable percentage of those cases considered microbiologically cured according to WHO still showed viable bacilli in the surgical specimen.
- Host factors and biomarkers should be included in future studies on therapeutical surgery of TB, both for DS and MDR/XDR-TB cases.

ObjectivesOur aim was to retrospectively compare clinical data and characteristics of removed lesions of the cohort of patients undergoing therapeutical surgery for their tuberculosis.Design and methodsDemographic and epidemiological details, clinical data, data on the surgery performed, macroscopic characteristics of the TB lesions removed, and outcome were recorded retrospectively from the 137 patients who underwent therapeutical surgery for their TB in Tbilisi, Georgia during 2014 and 2015.ResultsMen represented 70% of the included patients, presented more comorbidities and underwent operation earlier in terms of days between diagnostic and surgery. Women underwent operation at younger ages, and in MDR/XDR-TB cases, showed higher percentages of sputum conversion at >2 months and of fresh necrosis in the surgical specimens, suggesting a worse evolution. Half of cases were MDR/XDR-TB cases. In spite of being considered microbiologically cured according to WHO, a non despricable percentage of cases showed viable bacilli in the surgical specimen. Even if no causality could be statistically demonstrated, differences could be encountered according to gender and drug susceptibility of the responsible strains.ConclusionsAccording to our results, host factors such as gender, type of necrosis found in the lesions, size of lesions and presence of viable bacilli in the surgical specimen, should be included in future studies on therapeutical surgery of TB. As most of studies are done in MDR/XDR-TB, more data on DS-TB operated cases are needed. Our results also highlight that, in spite of achieving the microbiologically cured status, sterilization might not occur, and thus new biomarkers and new methods to evaluate the healing process of TB patients are urgently needed and radiological assays should be taken into account.