Long-term Outcome of Pulmonary Resection for Nontuberculous Mycobacterial Pulmonary Disease

Takanori Asakura, Nobutaka Hayakawa, Naoki Hasegawa, Ho Namkoong, Ken Takeuchi, Shoji Suzuki, Makoto Ishii, Tomoko Betsuyaku, Yoshiaki Abe, Motofumi Ouchi

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background. Pulmonary resection along with multiple antimicrobial therapy has produced favorable outcomes at a few centers. However, little is known regarding the risk factors for long-term survival and microbiological recurrence after pulmonary resection for nontuberculous mycobacterial pulmonary disease (NTMPD). We evaluated the long-term outcomes of pulmonary resection, including microbiological recurrence and survival. Methods. This retrospective cohort study included 125 patients (median age, 60 years) with NTMPD treated by pulmonary resection at two referral centers between January 1994 and August 2015. Results. Postoperative complications occurred in 27 patients (22%). The complication rate after pneumonectomy was significantly higher than those after other types of pulmonary resection (odds ratio, 4.1; 95% confidence interval [CI], 1.6-10.3; P =.005). The median follow-up period was 7.1 years. While 19 patients experienced microbiological recurrence, 26 died. Multivariate analysis revealed pneumonectomy (adjusted hazard ratio [aHR], 0.12; 95% CI,.007-.66; P =.0098) and cavitary lesions after surgery (aHR, 6.73; 95% CI, 1.68-22.7; P =.0095) to be predictors of microbiological recurrence and old age (aHR, 1.06; 95% CI, 1.01-1.13; P =.016), low body mass index (BMI; aHR for every 1-kg/m 2 increase, 0.72; 95% CI,.60-.85; P <.0001), pneumonectomy (aHR, 4.38; 95% CI, 1.78-11.3; P =.014), and remnant cavitary lesions (aHR, 3.53; 95% CI, 1.35-9.57; P =.011) to be predictors of poor prognosis. Conclusions. Patients who could benefit from pulmonary resection should be carefully selected considering age, BMI, remnant lesions after surgery, and type of pulmonary resection.

Original languageEnglish
Pages (from-to)244-251
Number of pages8
JournalClinical Infectious Diseases
Volume65
Issue number2
DOIs
Publication statusPublished - 2017 Jul 15

Fingerprint

Lung Diseases
Confidence Intervals
Lung
Pneumonectomy
Recurrence
Survival
Body Mass Index
Cohort Studies
Referral and Consultation
Multivariate Analysis
Retrospective Studies
Odds Ratio

Keywords

  • cavitary lesions.
  • mycobacterium avium complex (MAC)
  • nontuberculous mycobacteria (NTM)
  • pneumonectomy
  • pulmonary resection

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Long-term Outcome of Pulmonary Resection for Nontuberculous Mycobacterial Pulmonary Disease. / Asakura, Takanori; Hayakawa, Nobutaka; Hasegawa, Naoki; Namkoong, Ho; Takeuchi, Ken; Suzuki, Shoji; Ishii, Makoto; Betsuyaku, Tomoko; Abe, Yoshiaki; Ouchi, Motofumi.

In: Clinical Infectious Diseases, Vol. 65, No. 2, 15.07.2017, p. 244-251.

Research output: Contribution to journalArticle

Asakura, Takanori ; Hayakawa, Nobutaka ; Hasegawa, Naoki ; Namkoong, Ho ; Takeuchi, Ken ; Suzuki, Shoji ; Ishii, Makoto ; Betsuyaku, Tomoko ; Abe, Yoshiaki ; Ouchi, Motofumi. / Long-term Outcome of Pulmonary Resection for Nontuberculous Mycobacterial Pulmonary Disease. In: Clinical Infectious Diseases. 2017 ; Vol. 65, No. 2. pp. 244-251.
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T1 - Long-term Outcome of Pulmonary Resection for Nontuberculous Mycobacterial Pulmonary Disease

AU - Asakura, Takanori

AU - Hayakawa, Nobutaka

AU - Hasegawa, Naoki

AU - Namkoong, Ho

AU - Takeuchi, Ken

AU - Suzuki, Shoji

AU - Ishii, Makoto

AU - Betsuyaku, Tomoko

AU - Abe, Yoshiaki

AU - Ouchi, Motofumi

PY - 2017/7/15

Y1 - 2017/7/15

N2 - Background. Pulmonary resection along with multiple antimicrobial therapy has produced favorable outcomes at a few centers. However, little is known regarding the risk factors for long-term survival and microbiological recurrence after pulmonary resection for nontuberculous mycobacterial pulmonary disease (NTMPD). We evaluated the long-term outcomes of pulmonary resection, including microbiological recurrence and survival. Methods. This retrospective cohort study included 125 patients (median age, 60 years) with NTMPD treated by pulmonary resection at two referral centers between January 1994 and August 2015. Results. Postoperative complications occurred in 27 patients (22%). The complication rate after pneumonectomy was significantly higher than those after other types of pulmonary resection (odds ratio, 4.1; 95% confidence interval [CI], 1.6-10.3; P =.005). The median follow-up period was 7.1 years. While 19 patients experienced microbiological recurrence, 26 died. Multivariate analysis revealed pneumonectomy (adjusted hazard ratio [aHR], 0.12; 95% CI,.007-.66; P =.0098) and cavitary lesions after surgery (aHR, 6.73; 95% CI, 1.68-22.7; P =.0095) to be predictors of microbiological recurrence and old age (aHR, 1.06; 95% CI, 1.01-1.13; P =.016), low body mass index (BMI; aHR for every 1-kg/m 2 increase, 0.72; 95% CI,.60-.85; P <.0001), pneumonectomy (aHR, 4.38; 95% CI, 1.78-11.3; P =.014), and remnant cavitary lesions (aHR, 3.53; 95% CI, 1.35-9.57; P =.011) to be predictors of poor prognosis. Conclusions. Patients who could benefit from pulmonary resection should be carefully selected considering age, BMI, remnant lesions after surgery, and type of pulmonary resection.

AB - Background. Pulmonary resection along with multiple antimicrobial therapy has produced favorable outcomes at a few centers. However, little is known regarding the risk factors for long-term survival and microbiological recurrence after pulmonary resection for nontuberculous mycobacterial pulmonary disease (NTMPD). We evaluated the long-term outcomes of pulmonary resection, including microbiological recurrence and survival. Methods. This retrospective cohort study included 125 patients (median age, 60 years) with NTMPD treated by pulmonary resection at two referral centers between January 1994 and August 2015. Results. Postoperative complications occurred in 27 patients (22%). The complication rate after pneumonectomy was significantly higher than those after other types of pulmonary resection (odds ratio, 4.1; 95% confidence interval [CI], 1.6-10.3; P =.005). The median follow-up period was 7.1 years. While 19 patients experienced microbiological recurrence, 26 died. Multivariate analysis revealed pneumonectomy (adjusted hazard ratio [aHR], 0.12; 95% CI,.007-.66; P =.0098) and cavitary lesions after surgery (aHR, 6.73; 95% CI, 1.68-22.7; P =.0095) to be predictors of microbiological recurrence and old age (aHR, 1.06; 95% CI, 1.01-1.13; P =.016), low body mass index (BMI; aHR for every 1-kg/m 2 increase, 0.72; 95% CI,.60-.85; P <.0001), pneumonectomy (aHR, 4.38; 95% CI, 1.78-11.3; P =.014), and remnant cavitary lesions (aHR, 3.53; 95% CI, 1.35-9.57; P =.011) to be predictors of poor prognosis. Conclusions. Patients who could benefit from pulmonary resection should be carefully selected considering age, BMI, remnant lesions after surgery, and type of pulmonary resection.

KW - cavitary lesions.

KW - mycobacterium avium complex (MAC)

KW - nontuberculous mycobacteria (NTM)

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KW - pulmonary resection

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