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Pulmonary resection for nontuberculous mycobacterial pulmonary disease: outcomes and risk factors for recurrence

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Abstract

Objectives

As the number of patients with nontuberculous mycobacterial pulmonary disease (NTMPD) increases, surgical treatment to control disease becomes more important. However, postoperative outcomes and predictors of recurrence have been insufficiently evaluated.

Methods

We retrospectively investigated 100 patients with NTMPD who underwent pulmonary resection from 2009 to 2016 at our institution. Clinical data of patients with and without postoperative recurrence were statistically compared. Recurrence was defined as microbiological re-identification or computed tomography findings highly suspicious for relapse after excluding other diseases. Recurrence-free survival was calculated using the Kaplan–Meier method. Survival curves were compared using the log-rank test. Predictive factors were evaluated using univariate and multivariate analyses.

Results

Nine patients experienced recurrence. A significant difference in recurrence-free survival was detected between patients with and without a positive preoperative sputum culture (P = 0.000942). Moreover, patients with a positive preoperative sputum smear (≥ 2 +) had a significantly higher recurrence rate than those who did not (P = 0.000216). Multivariate analysis revealed that preoperative sputum smear (≥ 2 +) is an independent risk factor for recurrence after pulmonary resection for NTMPD (odds ratio, 7.38; 95% confidential interval, 1.29–42.2; P = 0.024).

Conclusions

NTM discharge might have an impact on postoperative recurrence of NTMPD patients without residual cavitary lesions. Preoperative NTM discharge should be minimized by optimizing medical therapy before surgical treatment to improve the postoperative course. Intensive follow-up and prolonged postoperative medical therapy should be considered for patients without a sufficient reduction in bacterial discharge before pulmonary resection.

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Funding

There was no funding from any organizations or companies. Notation of prior abstract publication/presentation: None.

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Authors and Affiliations

  1. Department of Thoracic Surgery, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo, 204-8585, Japan

    Takuma Yotsumoto, Yuta Inoue & Takeshi Fukami

  2. Department of Respiratory Medicine, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo, 204-8585, Japan

    Hirotoshi Matsui

Authors
  1. Takuma Yotsumoto
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  2. Yuta Inoue
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  3. Takeshi Fukami
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  4. Hirotoshi Matsui
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Contributions

Yotsumoto T contributed to data collection, data analysis, and wrote the initial draft of the manuscript. Inoue Y and Fukami T designed the study, contributed to data analysis and interpretation, and assisted in the preparation of the manuscript.

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Correspondence to Takuma Yotsumoto.

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Yotsumoto, T., Inoue, Y., Fukami, T. et al. Pulmonary resection for nontuberculous mycobacterial pulmonary disease: outcomes and risk factors for recurrence. Gen Thorac Cardiovasc Surg 68, 993–1002 (2020). https://doi.org/10.1007/s11748-020-01326-1

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  • DOI: https://doi.org/10.1007/s11748-020-01326-1

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