Long-term results of pulmonary resection for atypical mycobacterial disease

From 1967 through 1981, 40 pulmonary resections were performed in 37 patients with Mycobacterium intracellulare infection. The patients ranged in age from 24 to 67 years, and 86% were men. Smoking and alcohol abuse seemed to be predisposing factors. Localized atypical mycobacterial infection unresponsive to chemotherapy was the operative indication for 38 of the 40 resections. All patients had cavitary disease. Mean length of preoperative drug treatment was 22 weeks. Sensitivity studies showed a very high incidence of in vitro drug resistance. Twenty-five patients were converted to sputum-negative status preoperatively; however, 23 of these had positive smears or cultures from their resected specimens. Resections performed included upper lobectomy in 31 patients, upper and middle lobectomy in 2 patients, upper lobectomy plus superior segmentectomy in 3, left completion pneumonectomy in 2, and wedge resection in 2. Two patients underwent staged bilateral upper lobectomies. There were no perioperative deaths. Complete follow-up in 33 patients (mean, 94 months) revealed only two reactivations at 3 and 5 years postoperatively. One of these patients is well following completion pneumonectomy 9 years after his first operation; the second patient responded to reinstitution of three-drug chemotherapy and is well 5 years later. Thirty-one patients have remained entirely free of disease. Excisional surgery remains the treatment of choice for localized M. intracellulare pulmonary infection.