Completion pneumonectomy for chronic mycobacterial disease.
OBJECTIVE
Patients with persistent pulmonary infections from mycobacterial disease present a difficult clinical challenge. These individuals typically have poor pulmonary function, malnutrition, and other comorbidities, and few guidelines exist regarding optimal therapy. We report our experience with completion pneumonectomy as part of a multidisciplinary treatment program for patients with recurrent, persistent mycobacterial disease.


METHODS
During a 9-year period, 26 consecutive patients underwent completion pneumonectomy for mycobacterial disease. All patients underwent intensive, guided preoperative antibiotic therapy and aggressive nutritional supplementation. Complete surgical resection of the remaining destroyed or infected lung tissue was performed, often through an extrapleural dissection with intrapericardial ligation of vessels. Vascularized tissue flaps were used whenever possible to buttress the bronchial stump closure. Postoperative management consisted of a multidisciplinary approach, with ongoing antibiotic and nutritional therapy.


RESULTS
The primary organisms were Mycobacterium avium complex (n = 15), Mycobacterium tuberculosis (n = 5), Mycobacterium abscessus (n = 3), Mycobacterium xenopi (n = 2), and Mycobacterium chelonae (n = 1). Operative mortality was 23% (6/26): respiratory failure or adult respiratory distress syndrome in 2 cases, sepsis in 2, bronchopleural fistula in 1, and pulmonary embolism in 1. Significant morbidity occurred in 46% (12/26). Among the 17 long-term survivors, sputum conversion or discontinuation of medications was achieved in 14 (82%). Mean length of follow-up was 45 months (range 4-105 months).


CONCLUSIONS
Completion pneumonectomy remains an important component of therapy in patients with mycobacterial disease who have had failure of previous therapy. Although associated with significant risks, successful outcomes can be achieved with an organized, multidisciplinary approach and careful postoperative follow-up.
Sherwood
J Timothy
JT
University of Colorado Health Sciences Center, Denver, Colo, USA.
Mitchell
John D
JD
Pomerantz
Marvin
M
D000328:Adult; D000368:Aged; D001983:Bronchial Fistula / Q000453:epidemiology; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000382:microbiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000601:surgery*; D010995:Pleural Diseases / Q000453:epidemiology; D011013:Pneumonectomy / Q000009:adverse effects; D016156:Respiratory Tract Fistula / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000601:surgery*