Adjuvant surgical treatment of nontuberculous mycobacterial lung disease

Ann Thorac Surg. 2013 Jul;96(1):287-91. doi: 10.1016/j.athoracsur.2013.03.008. Epub 2013 Apr 22.

Abstract

Background: According to the 2007 American Thoracic Society/Infectious Diseases Society of America statement on nontuberculous mycobacterial diseases, more evidence for the benefits of adjuvant nontuberculous mycobacterial lung disease surgical intervention is needed before its wide application can be recommended.

Methods: A retrospective review was conducted of 60 consecutive patients who met American Thoracic Society/Infectious Diseases Society of America diagnostic criteria and underwent pulmonary resection for localized nontuberculous mycobacterial lung disease between January 2007 and December 2011. All patients were receiving chemotherapy before resection.

Results: Included were 41 women (68%) and 19 men (32%), with a median age of 50 years (range, 20 to 72 years). Of these, 55 patients (92%) had Mycobacterium avium complex disease. Bronchiectatic disease was noted in 29 patients, cavitary disease in 25, both in 4, and nodular disease in 2. The indications for resection were a poor response to drug therapy in 52 patients, hemoptysis in 6, and a secondary infection in 2. Sixty-five pulmonary resections were performed: 1 pneumonectomy, 3 bilobectomies, 39 lobectomies, 17 segmentectomies, 3 lobectomies plus segmentectomies, and 2 wedge resections. There were no operative deaths, and all patients attained sputum-negative status postoperatively. Eleven postoperative complications occurred in 8 patients (12%); relapse was observed in only 2 (3%).

Conclusions: Pulmonary resection combined with chemotherapy is safe, with favorable treatment outcomes, for patients with localized nontuberculous mycobacterial lung disease. Our results support the liberal use of operations for nontuberculous mycobacterial lung disease whenever indicated.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Chemotherapy, Adjuvant
  • Diagnosis, Differential
  • Female
  • Follow-Up Studies
  • Humans
  • Lung Diseases / microbiology
  • Lung Diseases / therapy*
  • Male
  • Middle Aged
  • Mycobacterium Infections, Nontuberculous / diagnosis
  • Mycobacterium Infections, Nontuberculous / microbiology
  • Mycobacterium Infections, Nontuberculous / therapy*
  • Nontuberculous Mycobacteria / isolation & purification*
  • Pneumonectomy / methods*
  • Retrospective Studies
  • Sputum / microbiology*
  • Treatment Outcome
  • Young Adult

Substances

  • Anti-Bacterial Agents