Surgical treatment of non-tuberculous mycobacterial lung disease: strike in time

SETTING: The Netherlands.OBJECTIVE: To describe our experiences with the adjunctive role and benefits of surgery for lung disease due to non-tuberculous mycobacteria (NTM), specifically addressing its indications and timing.DESIGN: Retrospective medical file review of eight patients who underwent surgical treatment for NTM lung disease in the period January 2000 to January 2009, and review of the available literature.RESULTS: Therapy-resistant cavitary NTM disease was the most frequent indication for surgery; two patients underwent pneumonectomy for an infected destroyed lung. Mycobacterium avium was the most common causative agent. Surgery resulted in culture conversion in seven patients; one patient died 2 months after pneumonectomy. No relapses have been noted in the other seven after an average of 19 months of follow-up.CONCLUSIONS: Adjunctive surgical treatment for NTM lung disease yields encouraging results, similar to previously published case series. Careful patient selection, based on extent and type of disease as well as on cardiopulmonary fitness, is important. Potential benefits of surgery should be considered for every individual patient in whom NTM lung disease is diagnosed and re-evaluated after 6 months of treatment. Where possible, surgery should be pursued and conducted in a timely fashion.