Early Pulmonary Resection for Mycobacterium Avium Complex Lung Disease Treated With Macrolides and Quinolones

Masazumi Watanabe, Naoki Hasegawa, Akitoshi Ishizaka, Keisuke Asakura, Yotarao Izumi, Keisuke Eguchi, Masafumi Kawamura, Hirohisa Horinouchi, Koichi Kobayashi

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)2026-2030
Number of pages5
JournalAnnals of Thoracic Surgery
Volume81
Issue number6
DOIs
Publication statusPublished - 2006 Jun

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Mycobacterium avium Complex
Quinolones
Macrolides
Lung Diseases
Lung
Drug Therapy
Sputum
Bronchiectasis
Segmental Mastectomy
Vital Capacity
Forced Expiratory Volume

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Early Pulmonary Resection for Mycobacterium Avium Complex Lung Disease Treated With Macrolides and Quinolones. / Watanabe, Masazumi; Hasegawa, Naoki; Ishizaka, Akitoshi; Asakura, Keisuke; Izumi, Yotarao; Eguchi, Keisuke; Kawamura, Masafumi; Horinouchi, Hirohisa; Kobayashi, Koichi.

In: Annals of Thoracic Surgery, Vol. 81, No. 6, 06.2006, p. 2026-2030.

Research output: Contribution to journalArticle

Watanabe, M, Hasegawa, N, Ishizaka, A, Asakura, K, Izumi, Y, Eguchi, K, Kawamura, M, Horinouchi, H & Kobayashi, K 2006, 'Early Pulmonary Resection for Mycobacterium Avium Complex Lung Disease Treated With Macrolides and Quinolones', Annals of Thoracic Surgery, vol. 81, no. 6, pp. 2026-2030. https://doi.org/10.1016/j.athoracsur.2006.01.031
Watanabe, Masazumi ; Hasegawa, Naoki ; Ishizaka, Akitoshi ; Asakura, Keisuke ; Izumi, Yotarao ; Eguchi, Keisuke ; Kawamura, Masafumi ; Horinouchi, Hirohisa ; Kobayashi, Koichi. / Early Pulmonary Resection for Mycobacterium Avium Complex Lung Disease Treated With Macrolides and Quinolones. In: Annals of Thoracic Surgery. 2006 ; Vol. 81, No. 6. pp. 2026-2030.
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AU - Hasegawa, Naoki

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AU - Asakura, Keisuke

AU - Izumi, Yotarao

AU - Eguchi, Keisuke

AU - Kawamura, Masafumi

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N2 - 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.

AB - 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.

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