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Surgery has a role in the treatment of patients with atypical mycobacteria who fail medical treatment or have extensive disease localised to one lung. This case series reports over 15 years of experience from the Fukujuji Hospital, Tokyo, reviewing 53 patients who required pulmonary resection for resistant non-tuberculous mycobacterial infections. Of these, 11 underwent pneumonectomy. Patients were selected for pulmonary resection if they met the diagnostic criteria recommended by the American Thoracic Society for non-tuberculous mycobacterial disease and had sufficient cardiopulmonary reserve. The 11 chosen for pneumonectomy had multiple cavities in one lung or destruction of an entire lung. Four of the 11 had evidence of lesions in the contralateral lung; 10 had Mycobacterium avium and one had M abscessus.
There was no operative mortality. A major complication of pneumonectomy is bronchopleural fistula, especially for right pneumonectomy. In this series bronchopleural fistula occurred in three patients (27%), all right sided, detected on the chest radiograph before the patient developed symptoms, repaired and without subsequent empyema. These fistulae occurred from 2 weeks to 3 months postoperatively. Other postoperative complications included respiratory failure (1) and empyema (1). All patients became sputum negative after surgery with seven kept on chemotherapy for at least 6 months. The other four did not tolerate chemotherapy. Two patients died, both of respiratory failure, one 11 months postoperatively and the other 4 years later in the presence of recurrent disease.
Pneumonectomy has a role in the treatment of resistant non-tuberculous mycobacterium in patients with one lung severely affected. The majority of patients become sputum negative with continuing chemotherapy and the most common complication is bronchopleural fistula.
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