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Ann Thorac Surg 1998;66:325-330
© 1998 The Society of Thoracic Surgeons
a Department of Surgery, The University of Texas Health Center, Tyler, Texas, USA
b Department of Microbiology, The University of Texas Health Center, Tyler, Texas, USA
c The Center for Pulmonary Infectious Disease Control, The University of Texas Health Center, Tyler, Texas, USA
Address reprint requests to Dr Nelson, The University of Texas Health Center, PO Box 2003, Tyler, TX 75710
Presented at the Forty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Naples, FL, Nov 6–8, 1997.
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 avium-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%).
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