title: Risk factors that affect the surgical outcome in the management of focal bronchiectasis in a developed country.
abstract: BACKGROUND
  The purpose of this study was to demonstrate our surgical experience for focal bronchiectasis in the setting of modern diagnostic modalities and state-of-the-art medical treatment in a developed country.
  
  
  METHODS
  Thirty-one patients undergoing 33 lung resections for the treatment of focal bronchiectasis from 1991 to 2009 were reviewed. The mean age was 54 years. Twenty-nine patients (94%) were female; 21 patients (68%) had nontuberculous mycobacterial infection; and 22 patients (71%) received preoperative multiple-drug regimens containing clarithromycin. Five patients (16%) were in an immunocompromised status. All were diagnosed by chest computed tomography scan, and either the right middle lobe or left lingula were involved in 29 (94%). The curve for relapse-free interval was estimated by Kaplan-Meier methods. The factors that affected this curve were examined using Cox's regression analysis.
  
  
  RESULTS
  Operative morbidity and mortality were 18% and 0%, respectively. All patients became asymptomatic postoperatively. During the median follow-up of 48 months (11 to 216), 8 patients (26%) experienced recurrence, and the mean relapse-free interval was 34 months (3 to 216). By univariate analysis, an immunocompromised status (p=0.017), Pseudomonas aeruginosa infection (p=0.040), the preoperative extent of bronchiectatic lesion (p=0.013), and the extent of residual bronchiectasis after surgery (p=0.003) were significantly associated with the shorter relapse-free interval. By multivariate analysis, an immunocompromised status (p=0.039), Pseudomonas aeruginosa infection (p=0.033), and the extent of residual bronchiectasis (p=0.009) were independent and significant factors.
  
  
  CONCLUSIONS
  Complete resection of bronchiectasis while the disease is localized and is free from Pseudomonas aeruginosa infection is the key for a success. Also, immunocompromised status was suggested to be a risk factor.
authors: Section of Chest Surgery, Fukujuji Hospital, and Department of Mathematics, Tokyo University of Science, Tokyo, Japan. mykhrmt@a07.itscom.net
authors: Miyako
authors: M
authors: Hiramatsu
authors: Yuji
authors: Y
authors: Shiraishi
authors: Yutsuki
authors: Y
authors: Nakajima
authors: Etsuo
authors: E
authors: Miyaoka
authors: Naoya
authors: N
authors: Katsuragi
authors: Hidefumi
authors: H
authors: Kita
authors: Akira
authors: A
authors: Hyogotani
authors: Kiyomi
authors: K
authors: Shimoda
mesh_terms: D001987:Bronchiectasis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019049:Developed Countries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011013:Pneumonectomy / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome