title: Long-term Outcome of Pulmonary Resection for Nontuberculous Mycobacterial Pulmonary Disease.
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/m2 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.
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine.|Japan Society for the Promotion of Science, Tokyo.
authors.forename: Takanori
authors.initials: T
authors.lastname: Asakura
authors.affiliation: Department of Thoracic Surgery, Seirei Yokohama Hospital, Kanagawa.
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Hayakawa
authors.affiliation: Center for Infectious Diseases and Infection Control, Keio University School of Medicine.
authors.forename: Naoki
authors.initials: N
authors.lastname: Hasegawa
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine.|Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan.
authors.forename: Ho
authors.initials: H
authors.lastname: Namkoong
authors.affiliation: Department of Thoracic Surgery, Seirei Yokohama Hospital, Kanagawa.
authors.forename: Ken
authors.initials: K
authors.lastname: Takeuchi
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine.
authors.forename: Shoji
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine.
authors.forename: Makoto
authors.initials: M
authors.lastname: Ishii
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Betsuyaku
authors.affiliation: Department of Thoracic Surgery, Seirei Yokohama Hospital, Kanagawa.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Abe
authors.affiliation: Department of Thoracic Surgery, Seirei Yokohama Hospital, Kanagawa.
authors.forename: Motofumi
authors.initials: M
authors.lastname: Ouchi
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000382:microbiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery*; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: cavitary lesions; mycobacterium avium complex (MAC); nontuberculous mycobacteria (NTM); pneumonectomy; pulmonary resection