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Treatment outcomes of adjuvant resectional surgery for nontuberculous mycobacterial lung disease

BACKGROUND: Outcomes of antibiotic treatment for lung disease caused by nontuberculous mycobacteria (NTM) are unsatisfactory. The role of adjunctive surgery in the treatment of NTM lung disease is still unclear. METHODS: We conducted a retrospective review of 70 patients who underwent pulmonary rese...

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Autores principales: Kang, Hyung Koo, Park, Hye Yun, Kim, Dohun, Jeong, Byeong-Ho, Jeon, Kyeongman, Cho, Jong Ho, Kim, Hong Kwan, Choi, Yong Soo, Kim, Jhingook, Koh, Won-Jung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342798/
https://www.ncbi.nlm.nih.gov/pubmed/25887191
http://dx.doi.org/10.1186/s12879-015-0823-1
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author Kang, Hyung Koo
Park, Hye Yun
Kim, Dohun
Jeong, Byeong-Ho
Jeon, Kyeongman
Cho, Jong Ho
Kim, Hong Kwan
Choi, Yong Soo
Kim, Jhingook
Koh, Won-Jung
author_facet Kang, Hyung Koo
Park, Hye Yun
Kim, Dohun
Jeong, Byeong-Ho
Jeon, Kyeongman
Cho, Jong Ho
Kim, Hong Kwan
Choi, Yong Soo
Kim, Jhingook
Koh, Won-Jung
author_sort Kang, Hyung Koo
collection PubMed
description BACKGROUND: Outcomes of antibiotic treatment for lung disease caused by nontuberculous mycobacteria (NTM) are unsatisfactory. The role of adjunctive surgery in the treatment of NTM lung disease is still unclear. METHODS: We conducted a retrospective review of 70 patients who underwent pulmonary resection for NTM lung disease from March 2007 to February 2013. All patients received recommended antibiotic treatment before and after the surgery. RESULTS: A total of 70 patients underwent 74 operations. The median age of the patients was 50 years. Of the 70 patients, 45 (64%) had Mycobacterium avium complex infection (24 M. intracellulare and 21 M. avium) and 23 (33%) had M. abscessus complex infection (15 M. abscessus and 8 M. massiliense). Thirty-eight (54%) patients had the nodular bronchiectatic form and 28 (40%) had the fibrocavitary form of NTM lung disease. The indications for surgery were a poor response to drug therapy (n=52), remnant cavitary lesions and severe bronchiectasis (n=14), and hemoptysis (n=4). Preoperative sputum acid-fast bacilli staining results were positive in 44 (63%) patients, and sputum culture was positive in 54 (76%). The surgery included lobectomy or lobectomy plus segmentectomy (n=50, 68%), segmentectomy (n=11, 15%), pneumonectomy or completion pneumonectomy (n=8, 11%), bilobectomy or bilobectomy plus segmentectomy (n=4, 5%), and wedge resection (n=1, 1%). Postoperative complications occurred in 15 (21%) patients, including one postoperative death and bronchopleural fistula in 5 patients with the fibrocavitary form of the disease. A negative sputum culture was achieved and maintained in 57 (81%) patients. CONCLUSIONS: Although adjuvant pulmonary resection is associated with a relatively high complication rate, this procedure may provide a high level of treatment success for selected patients with NTM lung disease, such as those with a poor response to antibiotic treatment alone.
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spelling pubmed-43427982015-02-28 Treatment outcomes of adjuvant resectional surgery for nontuberculous mycobacterial lung disease Kang, Hyung Koo Park, Hye Yun Kim, Dohun Jeong, Byeong-Ho Jeon, Kyeongman Cho, Jong Ho Kim, Hong Kwan Choi, Yong Soo Kim, Jhingook Koh, Won-Jung BMC Infect Dis Research Article BACKGROUND: Outcomes of antibiotic treatment for lung disease caused by nontuberculous mycobacteria (NTM) are unsatisfactory. The role of adjunctive surgery in the treatment of NTM lung disease is still unclear. METHODS: We conducted a retrospective review of 70 patients who underwent pulmonary resection for NTM lung disease from March 2007 to February 2013. All patients received recommended antibiotic treatment before and after the surgery. RESULTS: A total of 70 patients underwent 74 operations. The median age of the patients was 50 years. Of the 70 patients, 45 (64%) had Mycobacterium avium complex infection (24 M. intracellulare and 21 M. avium) and 23 (33%) had M. abscessus complex infection (15 M. abscessus and 8 M. massiliense). Thirty-eight (54%) patients had the nodular bronchiectatic form and 28 (40%) had the fibrocavitary form of NTM lung disease. The indications for surgery were a poor response to drug therapy (n=52), remnant cavitary lesions and severe bronchiectasis (n=14), and hemoptysis (n=4). Preoperative sputum acid-fast bacilli staining results were positive in 44 (63%) patients, and sputum culture was positive in 54 (76%). The surgery included lobectomy or lobectomy plus segmentectomy (n=50, 68%), segmentectomy (n=11, 15%), pneumonectomy or completion pneumonectomy (n=8, 11%), bilobectomy or bilobectomy plus segmentectomy (n=4, 5%), and wedge resection (n=1, 1%). Postoperative complications occurred in 15 (21%) patients, including one postoperative death and bronchopleural fistula in 5 patients with the fibrocavitary form of the disease. A negative sputum culture was achieved and maintained in 57 (81%) patients. CONCLUSIONS: Although adjuvant pulmonary resection is associated with a relatively high complication rate, this procedure may provide a high level of treatment success for selected patients with NTM lung disease, such as those with a poor response to antibiotic treatment alone. BioMed Central 2015-02-19 /pmc/articles/PMC4342798/ /pubmed/25887191 http://dx.doi.org/10.1186/s12879-015-0823-1 Text en © Kang et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Kang, Hyung Koo
Park, Hye Yun
Kim, Dohun
Jeong, Byeong-Ho
Jeon, Kyeongman
Cho, Jong Ho
Kim, Hong Kwan
Choi, Yong Soo
Kim, Jhingook
Koh, Won-Jung
Treatment outcomes of adjuvant resectional surgery for nontuberculous mycobacterial lung disease
title Treatment outcomes of adjuvant resectional surgery for nontuberculous mycobacterial lung disease
title_full Treatment outcomes of adjuvant resectional surgery for nontuberculous mycobacterial lung disease
title_fullStr Treatment outcomes of adjuvant resectional surgery for nontuberculous mycobacterial lung disease
title_full_unstemmed Treatment outcomes of adjuvant resectional surgery for nontuberculous mycobacterial lung disease
title_short Treatment outcomes of adjuvant resectional surgery for nontuberculous mycobacterial lung disease
title_sort treatment outcomes of adjuvant resectional surgery for nontuberculous mycobacterial lung disease
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342798/
https://www.ncbi.nlm.nih.gov/pubmed/25887191
http://dx.doi.org/10.1186/s12879-015-0823-1
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