The OBJECTIVE was to reduce the risk of complications and mortality after pleuropneumonectomy in patients with pulmonary tuberculosis complicated by pleural empyema.METODS AND MATERIALS. The immediate and long-term results of surgical treatment were analyzed in 910 patients who underwent pneumonectomy between 1984 and 2021. Among these, 342 patients (37.6 %) underwent pleuropneu- monectomy (Group I), while 568 patients (62.4 %) underwent pneumonectomy (Group II). Group I was further divided into two subgroups. Subgroup Ia consisted of 278 patients (main group) who received stump-free suturing of the main bronchus according to D. B. Giller’s method, long-term drainage management of the pleural cavity using an original technique, and the proposed staged surgical tactics. Subgroup Ib comprised 64 patients who were treated using traditional methods for the main bronchus and puncture management of the pleural cavity.RESULTS. Postoperative complications were more frequent after pleuropneumonectomy (PPE); however, the mortality rate in Subgroup Ia and Group II did not significantly differ. In contrast, the hospital mortality rate in Subgroup Ib, which utilized traditional approaches for the treatment of the main bronchus and puncture management of the pleural cavity, was 2.3 times higher than the mortality rate after pneumonectomy (PE). The incidence of complications, mortality, recurrence of tuberculosis, and empyema differed significantly between Subgroups Ia and Ib, with the best outcomes observed in Subgroup Ia. These results are attributed to the applied method of treating the main bronchus, pleural cavity management, and differentiated surgical tactics.

Objective: To study and compare surgical risks and immediate effectiveness of surgical treatment in patients with multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB).Materials and methods: We examined immediate treatment outcomes of 1180 patients who underwent surgery for destructive MDRTB, pre-XDR-TB, and XDR-TB between 2011 and 2023. The patients were grouped: group 1 for patients with MDR-TB (744 cases) and group 2 for patients with pre-XDR-TB and XDR-TB (436 cases). Moreover, patients were further subdivided based on the extent of surgery.Results: The complete clinical response, ie, cavity closure and elimination of bacilli (CV-, MBT-), was achieved in all 405 patients who underwent radical surgery, in 673 (97.1%) of 694 patients who underwent semiradical surgery, and only in 10 (12.3%) of 81 patients who underwent palliative surgery.Conclusions: The immediate outcomes of surgical treatment for MDR-TB were superior in all parameters compared with those for pre-XDR-TB and XDR-TB; however, we found no significant differences when we evaluated treatment effectiveness in patients who underwent radical and semiradical surgery.