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Outcomes of adjunctive surgery for nontuberculous mycobacterial pulmonary disease
BACKGROUND: 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 institutio...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8496107/ https://www.ncbi.nlm.nih.gov/pubmed/34615499 http://dx.doi.org/10.1186/s12890-021-01679-0 |
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author | Kim, Joong-Yub Park, Samina Park, In Kyu Kang, Chang Hyun Kim, Young Tae Koh, Jaemoon Yim, Jae-Joon Kwak, Nakwon |
author_facet | Kim, Joong-Yub Park, Samina Park, In Kyu Kang, Chang Hyun Kim, Young Tae Koh, Jaemoon Yim, Jae-Joon Kwak, Nakwon |
author_sort | Kim, Joong-Yub |
collection | PubMed |
description | BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12890-021-01679-0. |
format | Online Article Text |
id | pubmed-8496107 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-84961072021-10-07 Outcomes of adjunctive surgery for nontuberculous mycobacterial pulmonary disease Kim, Joong-Yub Park, Samina Park, In Kyu Kang, Chang Hyun Kim, Young Tae Koh, Jaemoon Yim, Jae-Joon Kwak, Nakwon BMC Pulm Med Research BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12890-021-01679-0. BioMed Central 2021-10-06 /pmc/articles/PMC8496107/ /pubmed/34615499 http://dx.doi.org/10.1186/s12890-021-01679-0 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Kim, Joong-Yub Park, Samina Park, In Kyu Kang, Chang Hyun Kim, Young Tae Koh, Jaemoon Yim, Jae-Joon Kwak, Nakwon Outcomes of adjunctive surgery for nontuberculous mycobacterial pulmonary disease |
title | Outcomes of adjunctive surgery for nontuberculous mycobacterial pulmonary disease |
title_full | Outcomes of adjunctive surgery for nontuberculous mycobacterial pulmonary disease |
title_fullStr | Outcomes of adjunctive surgery for nontuberculous mycobacterial pulmonary disease |
title_full_unstemmed | Outcomes of adjunctive surgery for nontuberculous mycobacterial pulmonary disease |
title_short | Outcomes of adjunctive surgery for nontuberculous mycobacterial pulmonary disease |
title_sort | outcomes of adjunctive surgery for nontuberculous mycobacterial pulmonary disease |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8496107/ https://www.ncbi.nlm.nih.gov/pubmed/34615499 http://dx.doi.org/10.1186/s12890-021-01679-0 |
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