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Long-term Outcomes of Adjunctive Lung Resection for Nontuberculous Mycobacteria Pulmonary Disease
1Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Background:
Adjunctive lung resection is recommended for select patients with nontuberculous mycobacteria (NTM) pulmonary disease (PD). However, data are limited on long-term recurrence rates in patients infected with major pathogens, including Mycobacterium avium complex (MAC) and Mycobacterium abscessus (MABC).
Methods:
In this prospective observational study, we retrospectively analyzed data from 125 patients with MAC-PD (n = 90) or MABC-PD (n = 35) who underwent adjunctive lung resection. We evaluated microbiological response, postoperative complications, recurrence, and all-cause mortality over a median 80-month follow-up.
Results:
Persistent culture positivity (64%) was the most common indication for surgery, followed by hemoptysis, recurrent pneumonia, or radiologic deterioration. Postoperative complications occurred in 18 (14%) patients, with no surgery-related deaths. Treatment outcomes did not significantly differ between the MAC- and MABC-PD groups. Cure with culture conversion was achieved in 112 (90%) patients. Recurrence occurred in 37 (33%) of 112 patients, of which 18 (49%) cases were attributed to reinfection by different NTM species or subspecies. The MAC group had higher recurrence rates than the MABC group (Kaplan-Meier curve, log-rank test, P = .043) and was significantly associated with recurrence in the multivariable analysis (adjusted hazard ratio, 2.71; 95% CI, 1.23-5.99). However, mortality was higher in the MABC-PD group than the MAC-PD group (7/35 vs 4/90, P = .006).
Conclusions:
Adjunctive lung resection with antibiotics helps to reduce bacterial burden and manage symptoms in patients with NTM-PD. However, it does not prevent recurrence, which is mostly caused by reinfection.
Insights
Adjunctive lung resection for nontuberculous mycobacteria (NTM) pulmonary disease (PD) aids symptom management but recurrence remains high, often due to reinfection. Long-term follow-up shows varied outcomes for Mycobacterium avium complex (MAC) and Mycobacterium abscessus (MABC) infections.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Surgical Oncology
Background:
- Adjunctive lung resection is a treatment option for select patients with nontuberculous mycobacteria (NTM) pulmonary disease (PD).
- Limited data exist on long-term recurrence rates following lung resection for major NTM pathogens, specifically Mycobacterium avium complex (MAC) and Mycobacterium abscessus (MABC).
Purpose of the Study:
- To evaluate the long-term outcomes of adjunctive lung resection in patients with MAC-PD and MABC-PD.
- To assess recurrence rates, microbiological response, postoperative complications, and mortality after lung resection for NTM-PD.
Main Methods:
- Prospective observational study with retrospective data analysis of 125 patients undergoing adjunctive lung resection for MAC-PD (n=90) or MABC-PD (n=35).
- Evaluation of microbiological response, complications, recurrence, and mortality over a median 80-month follow-up period.
- Kaplan-Meier curves and multivariable analysis were used to compare outcomes between MAC and MABC groups.
Main Results:
- Persistent culture positivity was the primary indication for surgery (64%).
- Overall cure with culture conversion was achieved in 90% of patients; however, recurrence occurred in 33%, largely attributed to reinfection.
- The MAC group exhibited higher recurrence rates (P=.043) and MABC group had higher mortality (P=.006) compared to their counterparts.
Conclusions:
- Adjunctive lung resection, combined with antibiotics, effectively reduces bacterial burden and manages symptoms in NTM-PD.
- Lung resection does not prevent recurrence, which is frequently caused by reinfection with different NTM species.
- Outcomes differed between MAC and MABC infections, with MAC associated with higher recurrence and MABC with higher mortality.
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