Long-term Outcome of Pulmonary Resection for Nontuberculous Mycobacterial Pulmonary Disease

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/m 2 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.