The global emergence and spread of multidrug resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) has led to the reexamination of surgical therapy as a possible adjunctive therapy for the treatment of drug-resistant TB. We present a case of a 26-year-old HIV-seronegative patient with pulmonary XDR-TB refractory to medical therapy. Surgical resection of the patient’s solitary cavitary lesion was performed as adjunctive treatment and a successful outcome with a combination of surgery and medical therapy was achieved. We review the history of surgical therapy for TB and the literature published on the role of surgical therapy in the treatment of MDR- and XDR-TB. A total of 26 case series and cohort studies were reviewed demonstrating surgical resection is beneficial in the treatment of drug-resistant TB; however, the results may not be applicable to all settings as all studies were observational, tended to select “healthier” TB patients, and all surgeries were performed at specialized thoracic surgery centers. Additional well-designed studies are needed to determine the efficacy of surgery in the treatment of drug-resistant TB.

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