HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Yuji Shiraishi Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Shiraishi, Y. Articles by Konno, H. Search for Related Content PubMed PubMed Citation Articles by Shiraishi, Y. Articles by Konno, H. Related Collections Lung - other

Eur J Cardiothorac Surg 2002;21:314-318
© 2002 Elsevier Science NL

Surgery for Mycobacterium avium complex lung disease in the clarithromycin era

Section of Chest Surgery, Fukujuji Hospital, 3-1-24, Matsuyama, Kiyose, Tokyo, Japan

Received 10 September 2001; received in revised form 18 November 2001; accepted 24 November 2001.

* Corresponding author. Tel.: +81-424-91-4111; fax: +81-424-92-4765
e-mail: yujishi{at}mvb.biglobe.ne.jp

Objective: Since the introduction of clarithromycin, it has been assumed that pulmonary Mycobacterium avium complex (MAC) disease can be treated with medication alone. This study examines whether surgery can still play an important role in the management of MAC lung disease in the current era. Methods: Between April 1993 and January 2001, 21 patients (11 men and 10 women) underwent a pulmonary resection for MAC infection. The median age of the patients was 56 years (range: 27–67 years). None of the patients were immunocompromised. Regimens employing clarithromycin were initiated preoperatively in all patients. The indications for surgery were failure of drug therapy in 19 patients and discontinuation of chemotherapy because of drug toxicity in two patients. The pulmonary resections (19 right lung, 2 left lung) performed included lobectomy in 16 patients, pneumonectomy in three, bilobectomy in one, and lobectomy plus segmentectomy in one. Results: All of the patients survived the surgery. Six major postoperative complications occurred in six patients (28.6%) and these included two bronchopleural fistulas after right pneumonectomy, two space problems, one prolonged air leak, and one case of interstitial pneumonia. All postoperative complications were manageable, and four of these were treated surgically. All patients had sputum-negative status after their operation. Relapse occurred in two patients (9.5%) at six months and two years postoperative, respectively. The first patient, who originally had a right upper lobectomy, underwent a left upper lobectomy during the follow-up period, attaining sputum conversion. The second patient underwent a right pneumonectomy and then died of respiratory failure four years postoperatively. This one late death was the only fatality. Conclusions: Although it is associated with relatively high morbidity, surgery provides a high sputum conversion rate for patients whose MAC disease responds poorly to drug therapy. Even in the present clarithromycin era, pulmonary resection remains the treatment of choice when MAC lung disease has not been successfully eradicated by drug treatment alone.

Key Words: Mycobacterium avium complex • Pulmonary resection • Clarithromycin • Postoperative complication

This article has been cited by other articles:

				J. D. Mitchell, A. Bishop, A. Cafaro, M. J. Weyant, and M. Pomerantz Anatomic lung resection for nontuberculous mycobacterial disease. Ann. Thorac. Surg., June 1, 2008; 85(6): 1887 - 1892. [Abstract] [Full Text] [PDF]

				D. E. Griffith, T. Aksamit, B. A. Brown-Elliott, A. Catanzaro, C. Daley, F. Gordin, S. M. Holland, R. Horsburgh, G. Huitt, M. F. Iademarco, et al. An Official ATS/IDSA Statement: Diagnosis, Treatment, and Prevention of Nontuberculous Mycobacterial Diseases Am. J. Respir. Crit. Care Med., February 15, 2007; 175(4): 367 - 416. [Full Text] [PDF]

				M. Watanabe, N. Hasegawa, A. Ishizaka, K. Asakura, Y. Izumi, K. Eguchi, M. Kawamura, H. Horinouchi, and K. Kobayashi Early Pulmonary Resection for Mycobacterium Avium Complex Lung Disease Treated With Macrolides and Quinolones Ann. Thorac. Surg., June 1, 2006; 81(6): 2026 - 2030. [Abstract] [Full Text] [PDF]

				S. K. Field and R. L. Cowie Lung Disease Due to the More Common Nontuberculous Mycobacteria Chest, June 1, 2006; 129(6): 1653 - 1672. [Abstract] [Full Text] [PDF]

				J. Reich, S. K. Field, D. Fisher, and R. L. Cowie Treatment Outcome in Mycobacterium avium Pulmonary Disease: A Correction and Comment Chest, May 1, 2005; 127(5): 1864 - 1866. [Full Text] [PDF]

				Y. Shiraishi, Y. Nakajima, N. Katsuragi, M. Kurai, and N. Takahashi Pneumonectomy for nontuberculous mycobacterial infections Ann. Thorac. Surg., August 1, 2004; 78(2): 399 - 403. [Abstract] [Full Text] [PDF]

				S. K. Field, D. Fisher, and R. L. Cowie Mycobacterium avium complex Pulmonary Disease in Patients Without HIV Infection Chest, August 1, 2004; 126(2): 566 - 581. [Abstract] [Full Text] [PDF]

				S. K. Field and R. L. Cowie Treatment of Mycobacterium avium-intracellulare complex Lung Disease With a Macrolide, Ethambutol, and Clofazimine Chest, October 1, 2003; 124(4): 1482 - 1486. [Abstract] [Full Text] [PDF]