Anatomic lung resection for nontuberculous mycobacterial disease

Background. Chronic lung infections involving nontuberculous mycobacteria are often inadequately treated owing to concomitant lung parenchymal damage, leading to persistence of the offending organisms. Little is known about the results of surgical therapy as part of a multimodality approach to these infections. Methods. A retrospective review was conducted of 236 consecutive patients who underwent anatomic lung resection for nontuberculous mycobacteria disease at our institution as part of a multimodality treatment program. Results. In all, 236 patients underwent 265 operations. The average age was 54 years (range, 23 to 77). Fifty-three patients had prior thoracic procedures. All patients had in-vitro sensitivity testing of cultured organisms, and had several months of guided antibiotic therapy. Special emphasis was placed on nutritional status. Eighty percent of patients had Mycobacterium avium complex disease. Anatomic lung resection was performed in all patients, with 126 lobectomies, 55 segmentectomies, 44 pneumonectomies, and 40 mixed procedures. Sixty-seven patients had either muscle or omental transposition. Mortality rate was 2.6%. The major morbidity rate was 11.7%. Average length of stay was 6.5 days. Presence on postoperative bronchopleural fistula was associated with positive sputum at operation and right pneumonectomy, particularly right completion pneumonectomy. Conclusions. This series represents the largest cohort of patients in the literature to date who underwent operation for nontuberculous mycobacteria infection. Surgery for nontuberculous mycobacteria disease may be accomplished with minimal morbidity and mortality. A multidisciplinary approach including targeted antimicrobial therapy and complete anatomic resection is the key to success.