The impact of adjuvant surgical treatment of nontuberculous mycobacterial pulmonary disease on prognosis and outcome

Abstract

Background: Lung resection in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) has been reported to be associated with favorable outcomes. However, little is known regarding the risk and prognostic factors for refractory and recurrent cases. We aimed to evaluate the overall impact and benefit of adjuvant lung surgery by comparing NTM-PD patients who underwent adjuvant lung resection with those treated exclusively with antibiotics. We also investigated the efficacy of serum IgA antibody against glycopeptidolipid (GPL) core antigen (GPL core antibody) to monitor disease activity and predict the recurrence of disease after adjuvant lung resection.Methods: We retrospectively evaluated the clinical characteristics and surgical outcomes of 35 patients surgically treated for NTM-PD. Furthermore, we compared surgically treated patients and control patients treated exclusively with antibiotics who were matched statistically 1:1 using a propensity score calculated from age, sex, body mass index, and radiologic features of disease. Results: In the surgically treated patients, the median age was 58 (interquartile range, 47-65) years and 65.7% were female. Twenty-eight patients had Mycobacterium avium complex. Operations comprised four pneumonectomies, two bilobectomies, one bilobectomy plus segmentectomy, 17 lobectomies, two segmentectomies, and nine lobectomies plus segmentectomies. Postoperative complications occurred in seven patients (20%), there were no operative deaths, and 33 (94.3%) patients achieved negative sputum culture conversion. Refractory and recurrent cases were associated with remnant bronchiectasis, contralateral shadows, and positive acid-fast bacilli staining or culture. Of 28 statistically matched pairs, long-term sustained negative culture conversion was observed in 23 (82.2%) surgical group patients and in 14 (50.0%) non-surgical group patients (0.0438). The mortality rate was lower in the surgical group, but did not reach statistical significance (one in the surgical group and four in the non-surgical group, p = 0.3516). GPL core antibody was correlated with disease activity and recurrence.

Outcomes of Adjunctive Surgery for Nontuberculous Mycobacterial Pulmonary Disease

“…Only one patient required an additional surgical procedure, while the others recovered with conservative management. A larger proportion (86.6%) of patients who received VATS in the present study compared to those in other studies [9,11,12,17,18,20,26] may have improved the postoperative complication rate in our study.…”

“…We assessed treatment outcomes according to the de nitions provided by the NTM-NET consensus statement [23] and recent studies [16][17][18][19][20]. Negative culture conversion was de ned as three or more consecutive negative mycobacterial cultures from respiratory samples collected over at least 3 months.…”

“…While previous studies on the surgical outcomes of adjunctive surgery have provided meaningful guidance and insight, these ndings varied considerably by institution. For example, major outcomes such as negative sputum culture conversion or postoperative complications ranged from 57-100% and 0-46%, respectively [9][10][11][12][13][14][15][16][17][18][19][20]. Con icting results and lack of standardized guidelines provide little help for patients and clinicians alike regarding the decision to perform surgery.…”

First line treatment selection modifies disease course and long-term clinical outcomes in Mycobacterium avium complex pulmonary disease

“…CAM susceptibility was determined by broth microdilution (BrothMIC NTM; Kyokuto Pharmaceutical Industrial). CAM resistance was defined as MIC ≥ 32 µg/mL 33 . Susceptibility tests to CAM were performed before treatment initiation and at the time of suspected recurrence or development of refractory disease.…”

New/Different Look at the Presence of Aspergillus in Mycobacterial Pulmonary Diseases. Long-Term Retrospective Cohort Study

“…Prognostic factors for NTM-PD have been identified in many retrospective studies [ 3 , 13 , 14 , 15 ]. In our study, higher age ( p < 0.0001), low BMI ( p < 0.0001), high CRP levels ( p = 0.0077), cavitation ( p = 0.0036), and AFB stain positivity ( p = 0.0001) were significantly and independently associated with mortality.…”