Background: Tuberculosis is still one of the major causes of mortality and morbidity in the world with nearly 1.3 million deaths recorded in 2012. Multi drug resistant tuberculosis has caused high number of deaths and new infections in the same year. The optimal management of MDR TB has been retarded by lack of controlled trials to indicate a fixed drug regimen to be applied universally. Surgical resection, often involving lobectomy and pneumoctomy, is used in patients failing to show improvements with the drug therapy. Objective: To conduct systematic review meta-analysis on comparative evaluation of treatment for MDR TB with and without surgical resection. Methods: Eligible studies were identified from databases using key phrases MDR TB, MDR TB treatment, and clinical outcomes for MDR TB therapy. Statistical analysis was performed by Comprehensive meta-analysis (CMA) version 2.2.064 software. Results: Twenty (20) studies fully met the inclusion criteria. Meta-analysis was performed on 630 MDR patients with and 2149 patients without surgery. The analysis produced success rates of 0.845, 0.520, failure rates of 0.157, 0.100, death rates of 0.172, 0.084 and default rates of 0.184, 0.038 for the non-surgical and surgical groups respectively. Conclusion: Adjuvant surgical resection results in clinically significant increase in success rates of MDR TB therapy and a reduction in the rates of failure, death and default.