Pulmonary resection for Mycobacterium xenopi pulmonary infection

Background. Results of medical therapy for Mycobacterium xenopi pulmonary i nfection remain unreliable. Pulmonary resection may be beneficial to patien ts whose disease is localized and who can tolerate a resectional operation. Methods. Eighteen patients underwent pulmonary resection between 1991 and 2 000: 14 men and 4 women, with a mean age of 50 +/- 12 years (range 27 to 68 years). Indications for operation were either therapeutic (n = 9) or diagn ostic (n = 9). Four patients received antimycobacterial chemotherapy before their operation and 2 patients were HIV positive. Results. Therapeutic procedures included completion pneumonectomy (n = 1), lobectomy (n = 6), segmentectomy (n = 1), and bilateral wedge resection (n = 1). Diagnostic procedures included lobectomy (n = 1) and wedge resection (n = 8). Complete resection could be achieved in 15 patients (83%). There w as no in-hospital mortality. Postoperative complications included prolonged air leak (5 of 18 patients, 27.7%) and pleural effusion requiring insertio n of a new chest tube (3 of 18 patients, 16.6%). Mean hospital stay was 14 +/- 8 days. Follow-up was 100% complete. Eleven patients received antimycob acterial chemotherapy for 4 to 24 months, postoperatively. Late mortality w as 11% and was unrelated to progression of mycobacterial disease. After the operation, the sputum remained positive in only 2 patients (11%) with inco mplete resections. Fourteen patients were asymptomatic with no relapse at a mean follow-up of 38 +/- 22 months (range 85 to 13 months). Conclusions. Resection represents an important adjunct to chemotherapy for the treatment of M xenopi pulmonary disease. In the setting of localized no dular or cavitary disease, failure to respond to medical therapy, relapse a fter treatment discontinuation, coexistent aspergilloma or polymicrobial co ntamination, or patient intolerance of medical therapy, pulmonary resection can be undertaken with acceptable morbidity and mortality. (C) 2001 by The Society of Thoracic Surgeons.