Early pulmonary resection for Mycobacterium avium complex lung disease treated with macrolides and quinolones.
BACKGROUND
The purpose of this study was to examine the postoperative outcomes of patients with Mycobacterium avium complex (MAC) lung lesions persisting despite treatment with multiple antibiotics.


METHODS
Patients with localized pulmonary lesions persisting despite extensive state-of-the art antimicrobial chemotherapy became candidates for surgical resection. Twenty-two patients who were expected to retain sufficient postoperative pulmonary function were included in this study. These patients received chemotherapy for 2 to 37 months (mean, 17). Surgical procedures were lobectomy (n = 15), segmentectomy (n = 4), and partial lung resection (n = 6). Three patients underwent bilateral resections.


RESULTS
Mycobacterium avium complex causing bronchiectasis or cavitary lesions was detected preoperatively in all 22 patients. There was no major operative morbidity or mortality. Postoperative chemotherapy was continued for 6 to 35 months. All patients were alive and well at follow-ups ranging from 6 to 164 months (median, 46). Both vital capacity and forced expiratory volume in 1 second after surgery were maintained at 89% and 84% of the preoperative values, respectively. Mycobacterium avium complex disappeared from sputum after surgery in all patients. In 1 patient, 4 months after resection of a cavitary lesion, MAC-positive sputum presumed to be from the contralateral lung lesion became negative during continuation of chemotherapy.


CONCLUSIONS
The long-term outcomes of patients operated on for MAC resistant to antimicrobial chemotherapy were excellent. For such patients, we recommend surgery before the disease becomes exceedingly advanced and nonresectable. Additionally, in extensive disease, the excision of large cavitary bacterial foci may assist the medical management of contralateral lesions.
Watanabe
Masazumi
M
Department of Surgery, School of Medicine, Keio University, Tokyo, Japan. masazumi@sc.itc.keio.ac.jp
Hasegawa
Naoki
N
Ishizaka
Akitoshi
A
Asakura
Keisuke
K
Izumi
Yotarao
Y
Eguchi
Keisuke
K
Kawamura
Masafumi
M
Horinouchi
Hirohisa
H
Kobayashi
Koichi
K
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use; D001987:Bronchiectasis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D019090:Case Management; D017291:Clarithromycin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018942:Macrolides / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015269:Mycobacterium avium Complex / Q000302:isolation & purification; D015270:Mycobacterium avium-intracellulare Infection / Q000188:drug therapy / Q000601:surgery*; D011013:Pneumonectomy / Q000379:methods; D015363:Quinolones / Q000627:therapeutic use*; D013183:Sputum / Q000382:microbiology; D013905:Thoracoplasty; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents; D018942:Macrolides; D015363:Quinolones; D017291:Clarithromycin