Re-visiting the surgical role in treating chemotherapeutic-resistance pulmonary tuberculosis: Results from a systematic review and meta-analysis

Background The incidence and prevalence of multi-drug-resistant and extensively drug-resistant pulmonary tuberculosis are increasing, posing profound health concerns; therefore, surgical intervention is gaining popularity again. However, the effectiveness of surgical treatment needs to be reassessed. This study attempted to determine the efficacy of surgical treatment and chemotherapy compared to chemotherapy alone among patients with pulmonary tuberculosis. Methods A systematic search and meta-analysis were conducted from inception to June 2025 of the existing databases, including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar. All double-arm studies available in English published between 2005 and August 2019 were included. Among 618 studies, 468 were selected based on abstract review. Eight out of 468 (8/468) studies were double-arm retrospective cohorts and observational studies, which included 1929 persons who matched the inclusion criteria. To measure the success of the surgical intervention, we used the pooled rate ratio, loss of patient follow-up, and the incidence of mortality using the random effects heterogeneity model. Results Overall, there was no statistically significant difference in the treatment success rate (RR=1.24 (0.98-1.56), p = 0.07) and mortality rate (RR=1.82 (0.31-10.63, p = 0.51) between the two groups. Interestingly, the summary rate ratio (RR=0.41 (0.18-0.93), p = 0.03) showed that the surgical group had a considerably lower loss rate to follow-up than the non-surgical group. There was no evidence of heterogeneity amongst the trials (I2 =0 %, τ2 =0.00, df=2, p = 0.36). Conclusions The current meta-analysis was the first to use a factor of loss of follow-up collected from several reports as a predictive tool to assess the effectiveness of surgical participation in treating drug-resistant tuberculosis patients. The rate of patient loss to follow-up in the surgical group suggested that the combination approach of surgery and chemotherapy showed a potential superiority over chemotherapy alone.