Results of operation in Mycobacterium avium-intracellulare lung disease

Ann Thorac Surg. 1998 Aug;66(2):325-30. doi: 10.1016/s0003-4975(98)00401-9.


Background: Although operation remains part of the management of Mycobacterium avium-intracellulare lung disease, few series have assessed operation in the era of better therapeutic drugs (especially clarithromycin).

Methods: From January 1, 1989, through June 30, 1997, 28 patients with M avirum-intracellulare lung disease underwent pulmonary resection. All were receiving multidrug therapy (17 of 28 were receiving clarithromycin) before and after operation. Eight patients underwent pneumonectomy (6 right, 2 left); 20 patients underwent partial resections including 18 with upper lobe lobectomies (14 right, 4 left). The most common indications for operation were medical treatment failure (15) and as part of initial therapy (9).

Results: Mean postoperative follow-up was 39 months. Complications occurred in 9 of 28 patients (32%), and included persistent air leak requiring surgical correction (5), early postoperative death (2), and late bronchopleural fistulae (1 patient). Twenty-three of 26 patients were known to be acid fast bacilli culture negative within 1 month of operation. Only 1 of 26 patients who survived 2 years is known to have had a relapse.

Conclusions: Operation continues to play an important role in treatment of M avium-intracellulare lung disease. More than 90% of patients become culture negative and remain so when they continue to receive drugs. Although morbidity is relatively high, it is manageable and the 12-month mortality in the current series was low (7%).

MeSH terms

  • Adult
  • Aged
  • Antitubercular Agents / administration & dosage
  • Blood Loss, Surgical
  • Clarithromycin / therapeutic use
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Mycobacterium avium-intracellulare Infection / drug therapy
  • Mycobacterium avium-intracellulare Infection / microbiology
  • Mycobacterium avium-intracellulare Infection / surgery*
  • Pneumonectomy* / methods
  • Postoperative Complications
  • Recurrence
  • Reoperation
  • Treatment Outcome
  • Tuberculosis, Pulmonary / drug therapy
  • Tuberculosis, Pulmonary / microbiology
  • Tuberculosis, Pulmonary / surgery*


  • Antitubercular Agents
  • Clarithromycin