Original Articles
Results of operation in Mycobacterium avium-intracellulare lung disease

Presented at the Forty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Naples, FL, Nov 6–8, 1997.
https://doi.org/10.1016/S0003-4975(98)00401-9Get rights and content

Abstract

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%).

Section snippets

Material and methods

Surgical records of The University of Texas Health Center were screened retrospectively for all patients who had undergone thoracic operation for MAC disease between January 1, 1989, and June 30, 1997. Clinical and microbiological records on the identified patients were then reviewed. Patients were included if they had undergone thoracic operation for MAC lung disease, had multiple positive sputa for MAC, and met the recent American Thoracic Society criteria for lung disease due to the NTM [6].

Patients

Between January 1, 1989, and June 30, 1997, 28 patients with MAC lung disease underwent a thoracic operation. None of these patients were known to be or suspected of being positive for human immunodeficiency virus. These patients were part of more than 300 patients with proven or suspected MAC disease seen or evaluated by the medical service during this time period. Many were enrolled in multidrug treatment trials approved by the Institutional Human Subjects Investigational Committee that began

Comment

Operation continues to play an important role in the management of fibrocavitary M avium-intracellulare lung disease even with the development of newer, better drugs such as clarithromycin. Currently it appears that better than 90% of patients who undergo resection can achieve permanent control of their disease. Timing of surgical intervention is still problematic, and no real recommendations for who to operate on and when have been set forth for this disease.

The use of muscle flaps are

References (11)

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