BACKGROUND: Patients with persistent pulmonary infections due to mycobacterial disease present a difficult clinical challenge. These individuals typically have poor pulmonary function, malnutrition and other comorbidities, and few guidelines exist regarding optimal therapy. We report on our experience with completion pneumonectomy as part of a multidisciplinary treatment program in patients with recurrent, persistent mycobacterial disease.
METHODS: During a 10-year period, 26 consecutive patients underwent completion pneumonectomy for mycobacterial disease. All patients underwent intensive, guided preoperative antibiotic therapy and aggressive nutritional supplementation. Complete surgical resection of the remaining destroyed or infected lung tissue was performed, often through an extrapleural dissection with intrapericardial ligation of vessels. Vascularized tissue flaps were used whenever possible to buttress the bronchial stump closure. Postoperative management was achieved through a multidisciplinary approach with ongoing antibiotic and nutritional therapy.
RESULTS: The primary organism was mycobacterium avium complex (n=15), mycobacterium tuberculosis (n=5), mycobacterium abscessus (n=3), mycobacterium xenopi (n=2), or mycobacterium chelonae (n=1). Operative mortality was 23% (6/26), due to respiratory failure/ARDS in 2, sepsis in 2, bronchopleural fistula in 1, and pulmonary embolism in 1. Significant morbidity occurred in 46% (12/26). Of the 17 long-term survivors, sputum conversion or discontinuation of medications was achieved in 14 (82%). Mean length of follow-up was 45 months (range 4-105 months).
CONCLUSIONS: Completion pneumonectomy remains an important component in patients with mycobacterial disease who have failed previous therapy. Although associated with significant risks, successful outcomes can be achieved with an organized multidisciplinary approach and careful postoperative follow-up.

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