Pneumonectomy for nontuberculous mycobacterial infections.
BACKGROUND
Pneumonectomy is considered in the treatment of nontuberculous mycobacterial infections when an entire lung is affected. However, this procedure carries high morbidity. We report on our experience in using pneumonectomy for treating patients with nontuberculous mycobacterial infections.


METHODS
Between 1983 and 2002, 53 patients infected with nontuberculous mycobacteria underwent 55 pulmonary resections. Of these patients, 11 (3 men, 8 women) underwent pneumonectomy (5 right, 6 left). Median age was 57 years (range, 43 to 69 years). Mycobacterium avium complex disease occurred in 10 patients and Mycobacterium abscessus disease in 1. Indications for pneumonectomy included multiple cavities in one lung and destruction of an entire lung. The bronchial stump was covered with a latissimus dorsi muscle flap in 7 patients and with an intercostal pedicle flap in 2.


RESULTS
Operating time ranged from 142 to 477 minutes (median, 360 minutes). The median intraoperative blood loss was 555 mL (range, 130 to 1,245 mL). There was no operative mortality. Bronchopleural fistula occurred in 3 patients. All fistulas were observed after right pneumonectomy, and were treated by reclosure of the bronchus. Empyema occurred in 1 patient, who was treated with irrigation. All patients achieved sputum-negative status after surgery. Two late deaths occurred. One patient died of respiratory failure 11 months after surgery. A second patient, the only patient who had recurrent disease, died of respiratory failure 4 years postoperatively.


CONCLUSIONS
Despite bronchial stump protection, right pneumonectomy carries a risk for bronchopleural fistula. Nonetheless, pneumonectomy can result in high cure rates in patients with nontuberculous mycobacterial infections.
Section of Chest Surgery, Fukujuji Hospital, 3-1-24 Matsuyama, Kiyose, Tokyo 204-8522, Japan. yujishi@mvb.biglobe.ne.jp
Yuji
Y
Shiraishi
Yutsuki
Y
Nakajima
Naoya
N
Katsuragi
Makoto
M
Kurai
Nobumasa
N
Takahashi
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D001983:Bronchial Fistula / Q000453:epidemiology / Q000209:etiology; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005402:Fistula / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000188:drug therapy / Q000601:surgery; D015270:Mycobacterium avium-intracellulare Infection / Q000188:drug therapy / Q000601:surgery*; D010995:Pleural Diseases / Q000453:epidemiology / Q000209:etiology; D011013:Pneumonectomy / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012008:Recurrence; D012131:Respiratory Insufficiency / Q000401:mortality; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*
D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents