Treatment outcomes of adjuvant resectional surgery for nontuberculous mycobacterial lung disease

Abstract

Background: Outcomes of antibiotic treatment for lung disease caused by nontuberculous mycobacteria (NTM) are unsatisfactory. The role of adjunctive surgery in the treatment of NTM lung disease is still unclear. Methods: We conducted a retrospective review of 70 patients who underwent pulmonary resection for NTM lung disease from March 2007 to February 2013. All patients received recommended antibiotic treatment before and after the surgery. Results: A total of 70 patients underwent 74 operations. The median age of the patients was 50 years. Of the 70 patients, 45 (64%) had Mycobacterium avium complex infection (24 M. intracellulare and 21 M. avium) and 23 (33%) had M. abscessus complex infection (15 M. abscessus and 8 M. massiliense). Thirty-eight (54%) patients had the nodular bronchiectatic form and 28 (40%) had the fibrocavitary form of NTM lung disease. The indications for surgery were a poor response to drug therapy (n=52), remnant cavitary lesions and severe bronchiectasis (n=14), and hemoptysis (n=4). Preoperative sputum acid-fast bacilli staining results were positive in 44 (63%) patients, and sputum culture was positive in 54 (76%). The surgery included lobectomy or lobectomy plus segmentectomy (n=50, 68%), segmentectomy (n=11, 15%), pneumonectomy or completion pneumonectomy (n=8, 11%), bilobectomy or bilobectomy plus segmentectomy (n=4, 5%), and wedge resection (n=1, 1%). Postoperative complications occurred in 15 (21%) patients, including one postoperative death and bronchopleural fistula in 5 patients with the fibrocavitary form of the disease. A negative sputum culture was achieved and maintained in 57 (81%) patients.

Pulmonary Disease Caused by Non-Tuberculous Mycobacteria

“…Van Ingen et al [47] reported that patients with MAC-PD more often had cavitary than nodular bronchiectatic disease in the Netherlands. Among patients with MAC-PD in France [47,52] there were lower rates of fibrocavitary than of nodular bronchiectatic disease, which is similar to the results of recent surveys in the USA and South East Asia [53,54,55,56,57,58]. Coinfection with MAC and M. abscessus subsp.…”

“…In contrast, the rates of fibrocavitary and unclassified forms in the same studies ranged from 17 to 40% and from 6 to 39%, respectively [54,55,56,57]. Few studies from Europe used the same radiopathological classifications, and comparative studies of the clinical spectrum of NTM-PD manifestations between Europe and other areas of the world are missing.…”

“…Surgery is an important option for patients with severe NTM-PD who have a poor response to medical therapy, localized cavitation, or severe nodular bronchiectatic disease; however, the complication rate can be high [54]. Two different retrospective analyses showed a persistent sputum culture conversion rate after surgery and postsurgical medical treatment in 81 and 88% of patients, respectively [54,104].…”

“…In several studies from different regions, infections with rapidly growing mycobacteria were less frequently and infections with M. kansasii , M. malmoense , or M. xenopi more frequently associated with fibrocavitary disease [43,44,54,55,58,60,61,62,63,64,65] (fig. 1), demonstrating a species dependency of the different forms of NTM disease.…”

Clinical Characteristics, Treatment Outcomes, and Resistance Mutations Associated with Macrolide-Resistant Mycobacterium avium Complex Lung Disease

“…In contrast, the combination of surgical resection and parenteral aminoglycoside was associated with favorable treatment outcomes in the treatment of macrolide-resistant MAC-LD (14), although surgical treatment may be associated with high complication rates (41,42). In the present study, two patients with the fibrocavitary form who underwent surgical resection combined with injectable medication achieved sputum-negative conversion.…”