While the prevalence of
pulmonary tuberculosis has been decreasing, the prevalence of nontuberculous mycobacterial
lung disease has been increasing. Unlike
tuberculosis, nontuberculous mycobacterial disease is not communicable. However, their indolent nature may result in extensive parenchymal destruction, causing
respiratory failure and vulnerability to airway
infection. Nontuberculous mycobacterial
lung disease, therefore, has been becoming a significant health problem. According to the 2007 American Thoracic Society/
Infectious Diseases Society of America statement on nontuberculous mycobacterial diseases, the primary treatment is a multidrug treatment regimen. However, its efficacy is less than satisfactory for Mycobacterium avium complex
lung disease, which is the most common type of nontuberculous mycobacterial
lung diseases, and for Mycobacterium abscessus
lung disease, which is notoriously resistant to chemotherapeutic drugs. The statement, therefore, has proposed a multidisciplinary treatment approach for these types of nontuberculous mycobacterial
lung diseases: a combination of multidrug treatment regimen and adjuvant resectional surgery. This review covers the rationale, indication, procedure, and outcome of surgical treatment of nontuberculous mycobacterial
lung disease. The rationale of surgery is to prevent disease progressing by removing the areas of lung most affected, harboring the largest amounts of mycobacteria. The indications for surgery include a poor response to
drug therapy, the development of
macrolide-resistant disease, or the presence of a significant disease-related complication such as
hemoptysis. The
surgical procedures of choice are various types of pulmonary resections, including wedge resection,
segmentectomy, lobectomy, or
pneumonectomy. The reported series have achieved favorable treatment outcomes in surgically treated patients with acceptable morbidity and mortality rates.