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

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ORIGINAL ARTICLE

Pulmonary resection for nontuberculous mycobacterial pulmonary disease: outcomes and risk factors for recurrence Takuma Yotsumoto1 · Yuta Inoue1 · Takeshi Fukami1 · Hirotoshi Matsui2 Received: 27 December 2019 / Accepted: 21 February 2020 © The Japanese Association for Thoracic Surgery 2020

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. Keywords  Nontuberculous mycobacteria · Nontuberculous mycobacterial infection · Pulmonary resection

Introduction Nontuberculous mycobacterial pulmonary disease (NTMPD), currently increasing world-wide especially in the developed countries [1–3], typically develops a pulmonary infection in the middle lobe or a lingular segment in Meeting Presentations: The 72nd Annual Scientific Meeting of the Japanese Association for Thoracic Surgery. * Takuma Yotsumoto tyotsumoto‑[email protected] 1



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



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

2

adult women exhibiting nodules, bronchiectasis, and cavities, similar to pulmonary tuberculosis. A