Surgical treatment of pulmonary diseases due to nontuberculous mycobacteria

Although the treatment of pulmonary diseases due to nontuberculous mycobacteria (NTM) requires the long-term use of antibiotics in combination, the treatment success rates are unsatisfactory. We evaluated the clinical characteristics and surgical outcomes of 23 patients with NTM lung diseases who had underwent pulmonary resection. The median age of the patients was 45 yr. Of the 23 patients, 10 had Mycobacterium avium-intracellulare complex infection, 12 had M. abscessus infection, and one had M. xenopi infection. The indications for surgery were antibiotic therapy failure (n=11), remnant cavitary lesion with high probability of relapse (n=8), and massive hemoptysis (n=4). The most common procedure was lobectomy (48%). Postoperative complications occurred in eight patients (35%), including postoperative pneumonia (n=3) and late bronchopleural fistula (n=2). Negative sputum culture conversion was achieved and maintained in all except two mortalities. Although it is associated with a relatively high complication rate, patients with NTM lung disease whose disease is localized to one lung and who can tolerate resectional surgery might be considered for surgery, if there has been poor response to drug therapy or if the patients develop significant disease-related complications such as hemoptysis.