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- Title
Outcomes of adjunctive surgery for nontuberculous mycobacterial pulmonary disease.
- Authors
Kim, Joong-Yub; Park, Samina; Park, In Kyu; Kang, Chang Hyun; Kim, Young Tae; Koh, Jaemoon; Yim, Jae-Joon; Kwak, Nakwon
- Abstract
<bold>Background: </bold>Owing to the unsatisfactory results of antibiotic treatment alone, surgical resection is currently considered as adjunctive therapy in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD). However, reports regarding the outcomes of surgery vary considerably by institution. Here, we investigated the surgical outcomes and risk factors associated with unfavorable outcomes after surgery.<bold>Methods: </bold>We analyzed patients with NTM-PD who underwent pulmonary resection at Seoul National University Hospital between January 1, 2006, and December 31, 2020, and assessed the types of surgical procedures, complications, and long-term outcomes. Multivariate logistic regression analysis was used to identify the risk factors associated with treatment refractoriness or recurrence after surgery.<bold>Results: </bold>Among 67 patients who underwent surgery during the study period, the most common indication for surgery was persistent culture positivity despite rigorous medical treatment (80.6%), followed by longstanding cavitary lesions or radiographic aggravation (10.4%) and massive hemoptysis (4.5%). Among 53 patients with positive mycobacterial cultures at the time of surgery, 38 (71.7%) achieved initial negative culture conversion, 9 (17.0%) of whom experienced recurrence. Nine (13.4%) patients experienced postoperative complications, which were managed without lasting morbidity and mortality. Female sex (adjusted odds ratio [aOR] 6.63; 95% confidence interval [CI] 1.04-42.4; P = .046), preoperative positive mycobacterial culture (aOR 5.87; 95 %CI 1.04-33.08; P = .045), and residual lesions (aOR 6.86; 95 %CI 1.49-31.56; P = .013) were associated with refractoriness or recurrence.<bold>Conclusions: </bold>Pulmonary resection is a reasonable treatment modality for patients with refractory NTM-PD or major complications such as massive hemoptysis. The potential risk factors associated with unfavorable outcomes included female sex, preoperative positive mycobacterial culture, and residual lesions after surgery.
- Subjects
SOUTH Korea; TREATMENT effectiveness; MYCOBACTERIAL diseases; PREOPERATIVE risk factors; LUNG diseases; OPERATIVE surgery; SPUTUM microbiology; MYCOBACTERIUM; DISEASE progression; MULTIVARIATE analysis; SURGICAL complications; RETROSPECTIVE studies; DISEASE relapse; LOGISTIC regression analysis; PNEUMONECTOMY
- Publication
BMC Pulmonary Medicine, 2021, Vol 21, Issue 1, p1
- ISSN
1471-2466
- Publication type
journal article
- DOI
10.1186/s12890-021-01679-0