Attitudes towards adjunctive surgical therapy for pulmonary TB in Europe: an ESGMYC, ESTS, and TBnet collaborative survey

BACKGROUND Data on the benefits of thoracic surgery for the treatment of pulmonary TB (PTB) are scarce. The majority of studies pertain to patients with multi- or extensively drug-resistant TB. We conducted this Europe-wide survey to evaluate attitudes towards thoracic surgery in TB care. METHODS We compiled a questionnaire of 17 questions on the respondents and their patients and on the modalities, indications, and outcomes of adjunctive surgery for PTB. The questions were distributed via the Tuberculosis Network European Trials Group (TBnet), ESCMID Study Group for Mycobacterial Infections (ESGMYC), and the European Society of Thoracic Surgeons (ESTS). RESULTS We received answers from 63 participants in 23 countries of the WHO European region. Surgery was mainly perceived to be reserved for specific clinical situations such as a differential diagnosis of cancer, a cavity with fungi/sequester, or a scarred stenosis of the draining bronchus. We observed substantial variations of attitudes towards surgical treatment between different specialties. CONCLUSION This study underscores a case-specific approach to adjunctive thoracic surgery in PTB. Differences in surgical availability and treatment attitudes suggest a need for specific, standardised guidelines. Future studies should aim to clarify the role of certain procedures and measure long-term outcomes of surgical treatment. .