Results of operation in Mycobacterium avium-intracellulare lung disease.
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%).
Nelson
K G
KG
Department of Surgery, The University of Texas Health Center, Tyler 75710, USA.
Griffith
D E
DE
Brown
B A
BA
Wallace
R J
RJ
D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage; D016063:Blood Loss, Surgical; D017291:Clarithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015270:Mycobacterium avium-intracellulare Infection / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D011013:Pneumonectomy / Q000379:methods; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*
D000995:Antitubercular Agents; D017291:Clarithromycin