Ji Yong Kim, J. Yun, Geon Dong Lee, Sehoon Choi, Hyeong Ryul Kim, Yong-Hee Kim, Seung-Il Park, Dong Kwan Kim
{"title":"Adjuvant surgical resection for nontuberculous mycobacterial pulmonary disease: Effectiveness and complications","authors":"Ji Yong Kim, J. Yun, Geon Dong Lee, Sehoon Choi, Hyeong Ryul Kim, Yong-Hee Kim, Seung-Il Park, Dong Kwan Kim","doi":"10.4103/atm.atm_237_23","DOIUrl":null,"url":null,"abstract":"\n \n Standard antibiotic treatment for nontuberculous mycobacteria pulmonary disease (NTMPD) has unsatisfactory success rates. Pulmonary resection is considered adjunctive therapy for patients with refractory disease or severe complications, but surgical indications and extent of resection remain unclear. We present surgical treatment outcomes for NTMPD and analyzes risk factors for unfavorable outcomes.\n \n \n \n We conducted a retrospective investigation of medical records for patients diagnosed with NTMPD who underwent surgical treatment at Asan Medical Center between 2007 and 2021. We analyzed clinical data including microbiological and surgical outcomes.\n \n \n \n A total of 71 NTMPD patients underwent thoracic surgery. Negative conversion of acid-fast bacillus (AFB) culture following pulmonary resection was observed in 51 (73.9%) patients. In terms of long-term outcomes, negative conversion was sustained in 38 cases (55.1%). Mortality occurred in 7 patients who underwent pulmonary resections for NTMPD. Statistically significant associations with factors for recurrence or non-negative conversion of AFB culture were found in older age (odds ratio [OR] =1.093, 95% confidence interval [CI]: 1.029–1.161, P = 0.004), male sex (OR = 0.251, 95% CI: 0.071–0.892, P = 0.033), and extensive NTMPD lesions involving three lobes or more (OR = 5.362, 95% CI: 1.315–21.857, P = 0.019). Interstitial lung disease (OR = 13.111, 95% CI: 1.554–110.585, P = 0.018) and pneumonectomy (OR = 19.667, 95% CI: 2.017–191.797, P = 0.018) were statistically significant risk factors for postoperative mortality.\n \n \n \n Pulmonary resection can be an effective adjuvant treatment option for NTMPD patients, with post-operative antibiotic treatment as the primary treatment. Careful patient selection is crucial, considering the associated risk factors and resectability due to complications and recurrence.\n","PeriodicalId":50760,"journal":{"name":"Annals of Thoracic Medicine","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Thoracic Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4103/atm.atm_237_23","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Standard antibiotic treatment for nontuberculous mycobacteria pulmonary disease (NTMPD) has unsatisfactory success rates. Pulmonary resection is considered adjunctive therapy for patients with refractory disease or severe complications, but surgical indications and extent of resection remain unclear. We present surgical treatment outcomes for NTMPD and analyzes risk factors for unfavorable outcomes.
We conducted a retrospective investigation of medical records for patients diagnosed with NTMPD who underwent surgical treatment at Asan Medical Center between 2007 and 2021. We analyzed clinical data including microbiological and surgical outcomes.
A total of 71 NTMPD patients underwent thoracic surgery. Negative conversion of acid-fast bacillus (AFB) culture following pulmonary resection was observed in 51 (73.9%) patients. In terms of long-term outcomes, negative conversion was sustained in 38 cases (55.1%). Mortality occurred in 7 patients who underwent pulmonary resections for NTMPD. Statistically significant associations with factors for recurrence or non-negative conversion of AFB culture were found in older age (odds ratio [OR] =1.093, 95% confidence interval [CI]: 1.029–1.161, P = 0.004), male sex (OR = 0.251, 95% CI: 0.071–0.892, P = 0.033), and extensive NTMPD lesions involving three lobes or more (OR = 5.362, 95% CI: 1.315–21.857, P = 0.019). Interstitial lung disease (OR = 13.111, 95% CI: 1.554–110.585, P = 0.018) and pneumonectomy (OR = 19.667, 95% CI: 2.017–191.797, P = 0.018) were statistically significant risk factors for postoperative mortality.
Pulmonary resection can be an effective adjuvant treatment option for NTMPD patients, with post-operative antibiotic treatment as the primary treatment. Careful patient selection is crucial, considering the associated risk factors and resectability due to complications and recurrence.
期刊介绍:
The journal will cover studies related to multidisciplinary specialties of chest medicine, such as adult and pediatrics pulmonology, thoracic surgery, critical care medicine, respiratory care, transplantation, sleep medicine, related basic medical sciences, and more. The journal also features basic science, special reports, case reports, board review , and more. Editorials and communications to the editor that explore controversial issues and encourage further discussion by physicians dealing with chest medicine.