Residual Destructive Lesions and Surgical Outcome in Mycobacterium avium complex Pulmonary Disease

Abstract Background Successful surgical treatment of patients with Mycobacterium avium complex pulmonary disease is thought to require complete removal of parenchymal destructive lesions. This study aimed to evaluate the short- and long-term outcomes and the predictors of microbiological recurrence after surgery for Mycobacterium avium complex pulmonary disease. Methods We conducted a retrospective review of 184 patients undergoing unilateral lung resection for Mycobacterium avium complex pulmonary disease at a single center in Japan between January 2008 and December 2017. Results The median age of the 184 patients was 55.5 years; 133 (72.3%) were females. All but 2 patients had anatomical lung resection. One hundred sixteen (63.0%) patients had limited disease and underwent complete resection; the remaining 68 (37.0%) patients had extensive disease and underwent “debulking” surgery. No operative mortalities occurred. Twenty-one morbidities occurred in 18 of 184 (9.8%) patients, including 3 (1.6%) bronchopleural fistulae. Postoperative sputum-negative status was achieved in 183 (99.5%) patients. Microbiological recurrences occurred in 15 (8.2%) patients. By multivariate analysis, extensive disease was an independent risk factor for recurrence (hazard ratio, 5.432; 95% confidence interval, 1.372-21.50; p = 0.016). Recurrence-free rates were significantly higher in patients with limited disease compared with those with extensive disease (99.0%, 97.4% and 95.0% vs 93.0%, 89.2% and 75.1% at 1, 3, and 5 years, respectively; p Conclusions Complete resection of parenchymal destructive lesions can achieve excellent microbiological control for patients with limited Mycobacterium avium complex pulmonary disease. The efficacy of “debulking” surgery in patients with extensive disease needs further investigation.