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Aydoğdu K, Çetin M, Yılmaz E, Mustafa Demiröz Ş, Türk İ, İncekara F, Alagöz A, Fındık G. Analysis of bronchiectasis patients who underwent video-assisted thoracoscopic surgery in a tertiary thoracic surgery center: Ten years of experience. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:202-211. [PMID: 38933320 PMCID: PMC11197415 DOI: 10.5606/tgkdc.dergisi.2024.25891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 02/11/2024] [Indexed: 06/28/2024]
Abstract
Background This study aimed to analyze our video-assisted thoracic surgery (VATS) experience in the surgical treatment of bronchiectasis and the reasons limiting VATS application. Methods Two hundred one patients (106 males, 95 females; mean age: 39.7±14.1 years; range, 12 to 68 years) who underwent surgical treatment for bronchiectasis between January 2012 and October 2021 were included in the retrospective study. Three groups were created based on the surgical technique used: VATS, thoracotomy, and patients who were converted from VATS to thoracotomy. Results The most significant presenting symptoms were cough (43%) and excessive sputum expectoration (40%). Surgical intervention was applied to the left side of 60% of the patients, and the most common resection performed in all three groups was left lower lobectomy. The rate of conversion from VATS to thoracotomy was 28.8%, and it was found that dense pleural adhesions were the most common reason. Revision surgery was performed on a total of 11 (5.47%) patients. The frequency of revision surgery did not differ significantly among the three groups (p=0.943). The most common postoperative complication was prolonged air leakage. There was no statistically significant difference in postoperative complication rates among the groups (p=0.417). The rate of surgical treatment of bronchiectasis with VATS was observed to have increased from 11.1% to 77.7% in our clinic. Conclusion In experienced hands, VATS can be safely applied in the surgical treatment of bronchiectasis.
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Affiliation(s)
- Koray Aydoğdu
- Department of Thoracic Surgery, University of Health Sciences, Ankara Etlik City Hospital, Ankara, Türkiye
| | - Mehmet Çetin
- Department of Thoracic Surgery, University of Health Sciences, Ankara Etlik City Hospital, Ankara, Türkiye
| | - Emre Yılmaz
- Department of Thoracic Surgery, University of Health Sciences, Ankara City Hospital, Ankara, Türkiye
| | - Şevki Mustafa Demiröz
- Department of Thoracic Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - İlteriş Türk
- Department of Thoracic Surgery, University of Health Sciences, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, Türkiye
| | - Funda İncekara
- Department of Thoracic Surgery, University of Health Sciences, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, Türkiye
| | - Ali Alagöz
- Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, Türkiye
| | - Göktürk Fındık
- Department of Thoracic Surgery, University of Health Sciences, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, Türkiye
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2
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Xu X, Dai J, Jin K, Liu X, Yang Y, Ge T, Li Q, Jiang C, He W, Wang H, Zhang P, Jiang G. Surgery for bronchiectasis-destroyed lung: feasibility of video-assisted thoracoscopic surgery, and surgical outcomes. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivad175. [PMID: 37930040 DOI: 10.1093/icvts/ivad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/12/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To provide the experience of surgical treatment for bronchiectasis-destroyed lung (BDL) and evaluate the feasibility of video-assisted thoracoscopic surgery (VATS). METHODS BDL patients underwent surgical treatment between January 2013 and June 2018 were included. Logistic regression was performed to assess factors for major complications, and Cox's regression was performed to assess factors affected symptomatic outcome. RESULTS Totally, 143 patients were treated by VATS (n = 64) and thoracotomy (n = 79). Nine (14.1%) cases scheduled for VATS were converted to thoracotomy for dense adhesions (n = 6) and frozen hilum (n = 3). The VATS group had a median chest tube duration, hospitalization and a time of returning to full activity of 4 days, 5 days and 1.5 months, respectively. Major complications occurred in 28 (19.6%) of all patients, 50.0% after pneumonectomy and 13.4% after lobectomy/extensive lobectomy. Multivariable analysis identified pneumonectomy [odds ratio, 3.64; 95% confidence interval (CI), 1.18-11.21] as a significant predictor for major complications. Overall, 141 (98.6%) patients benefitted from surgery (completely asymptomatic, n = 109; acceptable alleviation, n = 32). Thirty-four patients experienced relapse of the disease, including 13 with productive cough, 11 with haemoptysis and 10 with recurrent infections. Pseudomonas aeruginosa infection [hazard ratio (HR), 3.07; 95% CI, 1.38-6.83] and extent of remanent bronchiectatic areas (HR, 1.03; 95% CI, 1.00-1.05) were independent risk factors for shorter relapse free interval. CONCLUSIONS VATS for BDL is feasible in well-selected patients. Pneumonectomy increased the risk of postoperative major complications. Removing all BDL lesions contributed to satisfactory prognosis.
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Affiliation(s)
- Xinnan Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Kaiqi Jin
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Xiaogang Liu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Yang Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Tao Ge
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Qiuyuan Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Chao Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Wenxin He
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Haifeng Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
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3
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Taylor LJ, Mitchell JD. Surgical Resection in Nontuberculous Mycobacterial Pulmonary Disease. Clin Chest Med 2023; 44:861-868. [PMID: 37890922 DOI: 10.1016/j.ccm.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Rates of nontuberculous mycobacterial pulmonary disease are increasing worldwide, particularly in the United States and other developed countries. While multidrug antimicrobial therapy is the mainstay of treatment, surgical resection has emerged as an important adjunct. In this article, we will review the indications for surgery, preoperative considerations, surgical techniques, and postoperative outcomes.
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Affiliation(s)
- Lauren J Taylor
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado, 12631 East 17th Avenue, C-310, Aurora, CO 80045, USA
| | - John D Mitchell
- General Thoracic Surgery, Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado, 12631 East 17th Avenue, C-310, Aurora, CO 80045, USA.
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4
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Bruminhent J, López-Medrano F, Pogatchnik BP, Nascimento E, Namsiripongpun W, Yingchoncharoen T, Ngodngamthaweesuk M, Sukprapruet A, Naratreekoon B, Rodriguez-Goncer I, Hernández A, Polanco N, Andrés A, Aguado JM, Pouch SM, Clemente WT. Lung abscess and empyema in a heart transplant recipient from Thailand. Transpl Infect Dis 2023; 25:e13984. [PMID: 36305598 DOI: 10.1111/tid.13984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022]
Abstract
The case discussed involves a 69-year-old Thai woman who underwent orthotopic heart transplantation 9 months before this event. She presented with fever without localizing signs or symptoms. However, her chest images revealed mass-like consolidation in the left upper lobe. Blood culture and lung tissue identified Rhodococcus equi. She was successfully treated with a combination of antimicrobial therapy, optimization of immunosuppressants, and surgical resection.
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Affiliation(s)
- Jackrapong Bruminhent
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Ramathibodi Excellence Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Francisco López-Medrano
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Madrid, Spain.,Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Spain.,Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Ellen Nascimento
- Pulmonary Pathologist, Department of Pathology, University of São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Warunyu Namsiripongpun
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teerapat Yingchoncharoen
- Ramathibodi Excellence Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Montien Ngodngamthaweesuk
- Ramathibodi Excellence Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Division of Thoracic Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Araya Sukprapruet
- Somdech Phra Debaratana Medical Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Bundit Naratreekoon
- Ramathibodi Excellence Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Isabel Rodriguez-Goncer
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Madrid, Spain.,Department of Nephrology, University Hospital 12 de Octubre, Madrid, Spain
| | - Ana Hernández
- Department of Nephrology, University Hospital 12 de Octubre, Madrid, Spain
| | - Natalia Polanco
- Department of Nephrology, University Hospital 12 de Octubre, Madrid, Spain
| | - Amado Andrés
- Department of Nephrology, University Hospital 12 de Octubre, Madrid, Spain.,Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Spain
| | - José María Aguado
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Madrid, Spain.,Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Spain.,Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | - Stephanie M Pouch
- Division of Infectious Diseases, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Wanessa Trindade Clemente
- Liver Transplant Group-IAG, Hospital das Clínicas, Department of Laboratory Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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5
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Muacevic A, Adler JR, Cunha L, Cordeiro I, Baptista A. Invasive Pneumococcal Disease and COVID-19 Coinfection: A Series of Cases Admitted to an Intensive Care Unit. Cureus 2022; 14:e31876. [PMID: 36579230 PMCID: PMC9790083 DOI: 10.7759/cureus.31876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 11/26/2022] Open
Abstract
Pneumococcal infection is still a frequent disease. It can be classified as invasive when pneumococcus is isolated in a generally sterile fluid. Pneumonia is the most common infectious source of adult invasive pneumococcal disease (IPD), and several risk factors for IPD are well known. This case report presents three clinical cases of different manifestations of IPD. The two most severe cases had coinfection by SARS-CoV-2 at hospital admission.
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6
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Leite PHC, Mariani AW, Araujo PHXNDE, Lima CET, Braga F, Haddad R, Campos JRMDE, Pego-Fernandes PM, Terra RM. Robotic thoracic surgery for inflammatory and infectious lung disease: initial experience in Brazil. Rev Col Bras Cir 2021; 48:e20202872. [PMID: 34008797 PMCID: PMC10683415 DOI: 10.1590/0100-6991e-20202872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/08/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE in Latin America, especially Brazil, the use of a robotic platform for thoracic surgery is gradually increasing in recent years. However, despite tuberculosis and inflammatory pulmonary diseases are endemic in our country, there is a lack of studies describing the results of robotic surgical treatment of bronchiectasis. This study aims to evaluate the surgical outcomes of robotic surgery for inflammatory and infective diseases by determining the extent of resection, postoperative complications, operative time, and length of hospital stay. METHODS retrospective study from a database involving patients diagnosed with bronchiectasis and undergoing robotic thoracic surgery at three hospitals in Brazil between January of 2017 and January of 2020. RESULTS a total of 7 patients were included. The mean age was 47 + 18.3 years (range, 18-70 years). Most patients had non-cystic fibrosis bronchiectasis (n=5), followed by tuberculosis bronchiectasis (n=1) and lung abscess (n=1). The performed surgeries were lobectomy (n=3), anatomic segmentectomy (n=3), and bilobectomy (n=1). The median console time was 147 minutes (range 61-288 min.) and there was no need for conversion to open thoracotomy. There were no major complications. Postoperative complications occurred in one patient and it was a case of constipation with the need for an intestinal lavage. The median for chest tube time and hospital stay, in days, was 1 (range, 1-6 days) and 5 (range, 2-14 days) respectively. CONCLUSIONS robotic thoracic surgery for inflammatory and infective diseases is a feasible and safe procedure, with a low risk of complications and morbidity.
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Affiliation(s)
| | - Alessandro Wasum Mariani
- - Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
- - Rede D'Or - São Luiz, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
- - Hospital Sírio Libanês, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
| | - Pedro Henrique Xavier Nabuco DE Araujo
- - Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
- - Rede D'Or - São Luiz, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
- - Hospital Sírio Libanês, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
| | | | - Felipe Braga
- - Hospital Copa Star, Serviço de Cirurgia Torácica - Rio de Janeiro - RJ - Brasil
| | - Rui Haddad
- - Hospital Copa Star, Serviço de Cirurgia Torácica - Rio de Janeiro - RJ - Brasil
| | - José Ribas Milanez DE Campos
- - Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
| | - Paulo Manuel Pego-Fernandes
- - Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
- - Hospital Sírio Libanês, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
| | - Ricardo Mingarini Terra
- - Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
- - Rede D'Or - São Luiz, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
- - Hospital Sírio Libanês, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
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7
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Khalil HA, Marshall MB. 10 Commandments of Robotic Segmentectomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:127-131. [PMID: 33829926 DOI: 10.1177/15569845211004262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Hassan A Khalil
- 1861 Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Surgical Service, Veterans Affairs Boston Healthcare System, MA, USA
| | - M Blair Marshall
- 1861 Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Surgical Service, Veterans Affairs Boston Healthcare System, MA, USA
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8
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Failure to rescue after surgical re-exploration in lung resection. Surgery 2021; 170:257-262. [PMID: 33775395 DOI: 10.1016/j.surg.2021.02.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/23/2021] [Accepted: 02/10/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Surgical re-exploration after lung resection remains poorly characterized, although institutional series have previously reported its association with greater mortality and complications. The present study sought to examine the impact of institutional lung-resection volume on the incidence of and short-term outcomes after surgical re-exploration. METHODS The 2007 to 2018 National Inpatient Sample was used to identify all adults who underwent lobectomy or pneumonectomy. Hospitals were divided into tertiles based on institutional lung-resection caseload. Multivariable regressions were used to identify associations between independent covariates on clinical outcomes. RESULTS Of an estimated 329,273 patients, 3,592 (1.09%) were re-explored with decreasing incidence over time. Open and minimal access pneumonectomy among other factors were associated with greater odds of reoperation. Those re-explored had greater odds of mortality and complications as well as increased duration of stay and adjusted costs. Although risk of re-exploration was similar across hospital tertiles, reoperative mortality was significantly lower at high-volume hospitals. CONCLUSION Re-exploration after lung resection is uncommon; however, when occurring, it is associated with worse clinical outcomes. After re-exploration, high-volume center status was associated with reduced odds of mortality relative to low volume. Failure to rescue at lower-volume centers suggests the need for optimization of perioperative factors to decrease incidence of reoperation.
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9
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Extensive Lung Resection for Nontuberculous Mycobacterial Lung Disease With Multilobar Lesions. Ann Thorac Surg 2020; 111:253-260. [PMID: 32621813 DOI: 10.1016/j.athoracsur.2020.05.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/17/2020] [Accepted: 05/08/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Nontuberculous mycobacterial lung disease often spreads to multiple lobes, and extensive lung resection (ELR) is sometimes required to control the disease. The safety and feasibility of ELR for nontuberculous mycobacterial lung disease remain unclear, however. METHODS This retrospective study included patients with nontuberculous mycobacterial lung disease who underwent adjuvant lung resection. Characteristics were compared between patients who underwent ELR and those who underwent simple anatomic lung resection (SALR). The outcome data were analyzed by a Cox regression analysis. RESULTS A total of 146 patients underwent ELR (n = 54) or SALR (n = 92). ELR was associated with a longer operative time (306 vs 237 minutes; P < .001) and higher incidence of prolonged air leak (17% vs 3.3%; P = .016) than SALR. Rates of mortality, sputum culture conversion (positive to negative), and microbiological recurrence did not differ markedly between the groups. In the multivariate analysis, ELR was not a significant risk factor for an unfavorable outcome after nontuberculous mycobacterial lung disease surgery (hazard ratio, 2.23; 95% confidence interval, 0.82-6.03; P= .11). CONCLUSIONS ELR for nontuberculous mycobacterial lung disease has some drawbacks compared with SALR but seems as safe and feasible as SALR. ELR may provide improved disease control in some cases of nontuberculous mycobacterial lung disease with multilobar lesions.
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10
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The impact of adjuvant surgical treatment of nontuberculous mycobacterial pulmonary disease on prognosis and outcome. Respir Res 2020; 21:153. [PMID: 32546152 PMCID: PMC7298848 DOI: 10.1186/s12931-020-01420-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/10/2020] [Indexed: 11/10/2022] Open
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. CONCLUSIONS NTM-PD patients who underwent adjuvant lung resection experienced overall favorable outcomes and achieved sputum culture conversion more frequently. Long-term mortality may have been reduced by this procedure, and the level of GPL core antibody was shown to be a good clinical indicator of disease activity after surgery.
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11
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Recent advances and controversies in surgical intervention of nontuberculous mycobacterial lung disease: A literature review. J Formos Med Assoc 2020; 119 Suppl 1:S76-S83. [DOI: 10.1016/j.jfma.2020.04.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/14/2020] [Accepted: 04/27/2020] [Indexed: 11/21/2022] Open
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12
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Lommatzsch ST. Infection prevention and chronic disease management in cystic fibrosis and noncystic fibrosis bronchiectasis. Ther Adv Respir Dis 2020; 14:1753466620905272. [PMID: 32160809 PMCID: PMC7068740 DOI: 10.1177/1753466620905272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Bronchiectasis is a chronic lung disease (CLD) characterized by irreversible bronchial dilatation noted on computed tomography associated with chronic cough, ongoing viscid sputum production, and recurrent pulmonary infections. Patients with bronchiectasis can be classified into two groups: those with cystic fibrosis and those without cystic fibrosis. Individuals with either cystic fibrosis related bronchiectasis (CFRB) or noncystic fibrosis related bronchiectasis (NCFRB) experience continuous airway inflammation and suffer airway architectural changes that foster the acquisition of a unique polymicrobial community. The presence of microorganisms increases airway inflammation, triggers pulmonary exacerbations (PEx), reduces quality of life (QOL), and, in some cases, is an independent risk factor for increased mortality. As there is no cure for either condition, prevention and control of infection is paramount. Such an undertaking incorporates patient/family and healthcare team education, immunoprophylaxis, microorganism source control, antimicrobial chemoprophylaxis, organism eradication, daily pulmonary disease management, and, in some cases, thoracic surgery. This review is a summary of recommendations aimed to thwart patient acquisition of pathologic organisms, and those therapies known to mitigate the effects of chronic airway infection. A thorough discussion of airway clearance techniques and treatment of or screening for nontuberculous mycobacteria (NTM) is beyond the scope of this discussion.
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13
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Pulmonary resection for nontuberculous mycobacterial pulmonary disease: outcomes and risk factors for recurrence. Gen Thorac Cardiovasc Surg 2020; 68:993-1002. [PMID: 32146579 DOI: 10.1007/s11748-020-01326-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES As the number of patients with nontuberculous mycobacterial pulmonary disease (NTMPD) increases, surgical treatment to control disease becomes more important. However, postoperative outcomes and predictors of recurrence have been insufficiently evaluated. METHODS We retrospectively investigated 100 patients with NTMPD who underwent pulmonary resection from 2009 to 2016 at our institution. Clinical data of patients with and without postoperative recurrence were statistically compared. Recurrence was defined as microbiological re-identification or computed tomography findings highly suspicious for relapse after excluding other diseases. Recurrence-free survival was calculated using the Kaplan-Meier method. Survival curves were compared using the log-rank test. Predictive factors were evaluated using univariate and multivariate analyses. RESULTS Nine patients experienced recurrence. A significant difference in recurrence-free survival was detected between patients with and without a positive preoperative sputum culture (P = 0.000942). Moreover, patients with a positive preoperative sputum smear (≥ 2 +) had a significantly higher recurrence rate than those who did not (P = 0.000216). Multivariate analysis revealed that preoperative sputum smear (≥ 2 +) is an independent risk factor for recurrence after pulmonary resection for NTMPD (odds ratio, 7.38; 95% confidential interval, 1.29-42.2; P = 0.024). CONCLUSIONS NTM discharge might have an impact on postoperative recurrence of NTMPD patients without residual cavitary lesions. Preoperative NTM discharge should be minimized by optimizing medical therapy before surgical treatment to improve the postoperative course. Intensive follow-up and prolonged postoperative medical therapy should be considered for patients without a sufficient reduction in bacterial discharge before pulmonary resection.
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14
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Nontuberculous Mycobacteria Infection: Source and Treatment. CURRENT PULMONOLOGY REPORTS 2019. [DOI: 10.1007/s13665-019-00237-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Pereira MC, Athanazio RA, Dalcin PDTR, de Figueiredo MRF, Gomes M, de Freitas CG, Ludgren F, Paschoal IA, Rached SZ, Maurici R. Brazilian consensus on non-cystic fibrosis bronchiectasis. J Bras Pneumol 2019; 45:e20190122. [PMID: 31411280 PMCID: PMC6733718 DOI: 10.1590/1806-3713/e20190122] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/16/2019] [Indexed: 12/16/2022] Open
Abstract
Bronchiectasis is a condition that has been increasingly diagnosed by chest HRCT. In the literature, bronchiectasis is divided into bronchiectasis secondary to cystic fibrosis and bronchiectasis not associated with cystic fibrosis, which is termed non-cystic fibrosis bronchiectasis. Many causes can lead to the development of bronchiectasis, and patients usually have chronic airway symptoms, recurrent infections, and CT abnormalities consistent with the condition. The first international guideline on the diagnosis and treatment of non-cystic fibrosis bronchiectasis was published in 2010. In Brazil, this is the first review document aimed at systematizing the knowledge that has been accumulated on the subject to date. Because there is insufficient evidence on which to base recommendations for various treatment topics, here the decision was made to prepare an expert consensus document. The Brazilian Thoracic Association Committee on Respiratory Infections summoned 10 pulmonologists with expertise in bronchiectasis in Brazil to conduct a critical assessment of the available scientific evidence and international guidelines, as well as to identify aspects that are relevant to the understanding of the heterogeneity of bronchiectasis and to its diagnostic and therapeutic management. Five broad topics were established (pathophysiology, diagnosis, monitoring of stable patients, treatment of stable patients, and management of exacerbations). After this subdivision, the topics were distributed among the authors, who conducted a nonsystematic review of the literature, giving priority to major publications in the specific areas, including original articles, review articles, and systematic reviews. The authors reviewed and commented on all topics, producing a single final document that was approved by consensus.
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Affiliation(s)
- Mônica Corso Pereira
- . Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP - Campinas (SP) Brasil
| | - Rodrigo Abensur Athanazio
- . Divisão de Pneumologia, Instituto do Coração - InCor - Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Paulo de Tarso Roth Dalcin
- . Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
- . Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Porto Alegre (RS) Brasil
| | | | - Mauro Gomes
- . Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo (SP) Brasil
- . Equipe de Pneumologia, Hospital Samaritano, São Paulo (SP) Brasil
| | | | | | - Ilma Aparecida Paschoal
- . Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP - Campinas (SP) Brasil
| | - Samia Zahi Rached
- . Divisão de Pneumologia, Instituto do Coração - InCor - Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Rosemeri Maurici
- . Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil
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16
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Nathavitharana RR, Strnad L, Lederer PA, Shah M, Hurtado RM. Top Questions in the Diagnosis and Treatment of Pulmonary M. abscessus Disease. Open Forum Infect Dis 2019; 6:ofz221. [PMID: 31289727 PMCID: PMC6608938 DOI: 10.1093/ofid/ofz221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/09/2019] [Indexed: 12/17/2022] Open
Abstract
Mycobacterium abscessus disease is particularly challenging to treat, given the intrinsic drug resistance of this species and the limited data on which recommendations are based, resulting in a greater reliance on expert opinion. We address several commonly encountered questions and management considerations regarding pulmonary Mycobacterium abscessus disease, including the role of subspecies identification, diagnostic criteria for determining disease, interpretation of drug susceptibility test results, approach to therapy including the need for parenteral antibiotics and the role for new and repurposed drugs, and the use of adjunctive strategies such as airway clearance and surgical resection.
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Affiliation(s)
- Ruvandhi R Nathavitharana
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Luke Strnad
- Division of Infectious Diseases, Department of Medicine, Oregon Health and Sciences University, Portland, Oregon
- Epidemiology Programs, Oregon Health and Sciences University and Portland State University School of Public Health, Portland, Oregon
| | - Philip A Lederer
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Maunank Shah
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
- Baltimore City Health Department, Baltimore, Maryland
| | - Rocio M Hurtado
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Global Health Committee, Ethiopia and Cambodia
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17
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Fang L, Xu J, Wang L, He Z, Lv W, Hu J. Pulmonary nodular lymphoid hyperplasia: a rare benign disease with malignant mask. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:43. [PMID: 30906747 DOI: 10.21037/atm.2018.12.59] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Pulmonary nodular lymphoid hyperplasia (PNLH) is a rare benign disease lacking systematically clinical assessment. This study aims to explore the clinical features of PNLH and evaluate the safety and efficacy of different surgical approaches for PNLH. Methods Patients with confirmed PNLH in our department between March 2007 and August 2017 were retrospectively reviewed. The detail information of patients, including demographic characteristics, medical history, preoperative investigations, perioperative findings, postoperative conditions, and recurrence status, was collected and analyzed. Results A total of 67 patients with PNLH were diagnosed in our department, and 15 of them were suspected to have lung cancer by radiological examination before the surgery. 43 of 67 patients underwent sublobar resection and 24 patients underwent lobectomy. Compared with the lobectomy, sublobar resection showed more significant advantages in operation time (P<0.001), blood loss (P=0.001), volume of chest drainage (P=0.007), duration of chest drainage (P=0.001) and postoperative hospital stay (P=0.001). Conclusions The diagnosis of PNLH before operation is challenging and it should be taken into consideration in the differential diagnosis of lung nodules. Compared with lobectomy, sublobar resection is an alternative approach for the treatment of PNLH.
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Affiliation(s)
- Likui Fang
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jinming Xu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Luming Wang
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Zhehao He
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Wang Lv
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jian Hu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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18
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Abstract
Adjuvant surgical resection in the setting of pulmonary nontuberculous mycobacterial (NTM) infection removes focal parenchymal disease thought to serve as a poorly perfused "reservoir" for organisms, thus resistant to standard antimicrobial therapy. Removal of these areas of damaged lung is felt to enhance the effectiveness of the medical treatment. In general, these operations are associated with low morbidity and mortality, although resections that are more extensive carry higher risk. Many of the planned operations may be performed with minimally invasive techniques. More data are needed regarding long-term outcomes in these patients.
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Affiliation(s)
- John D Mitchell
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Academic Office 1, Room 6602, C-310, 12631 East 17th Avenue, Aurora, CO 80045, USA.
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19
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Bostock IC, Sheikh F, Millington TM, Finley DJ, Phillips JD. Contemporary outcomes of surgical management of complex thoracic infections. J Thorac Dis 2018; 10:5421-5427. [PMID: 30416790 DOI: 10.21037/jtd.2018.08.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Surgery plays an important role in the management of complex thoracic infections (CTIs). We aimed to describe the contemporary surgical outcomes of CTIs. Methods The 2014-2017 National Surgical Quality Improvement Program (NSQIP) database was queried for patients with the following procedures: bilobectomy, decortication, lung release, lobectomy, thoracoscopic lobectomy, thoracoscopic pleurodesis, thoracoscopic wedge resection, thoracoscopic biopsy, thoracoscopy, thoracotomy, thoracotomy with wedge resection, thoracotomy with decortication, and thoracotomy with lobectomy. Patients were classified into: drainage procedures (DP) and lung resection (LR). Descriptive statistics and univariate/multivariate analysis were executed. A P value <0.05 was considered significant. Results A total of 1,275 patients (30.3%) underwent surgical management for a CTI. Nine hundred and seven patients (71.1%) underwent a DP, and 368 patients (28.9%) underwent a LR. A thoracic surgeon performed 64% and 79% of cases in the DP and LR groups, respectively. On univariate analysis, the patients in the LR group were less likely to be male, diabetic, active smokers, dyspneic on exertion, hypertensive, malnourished, or American Society of Anesthesiologist (ASA) >3. There was no difference in overall postoperative complications, re-intubation, or reoperation between groups. The patients in the LR group were less likely to develop sepsis or respiratory failure. There was no difference in 30-day mortality between groups (5.3% vs. 3.8%, P=0.26). The total length of stay was 13.82±10.17 and 8.7±15.05 days, in the DP and LR groups, respectively (P=0.001). Multivariate analysis revealed increased risk of 30-day mortality was associated with age, preoperative steroid use, renal failure, leukocytosis, pulmonary embolism, and sepsis. Conclusions CTI's are a common indication for thoracic surgical management. This contemporary, national sampling demonstrates that approximately one third of identified cases were associated with a LR. These cases demonstrated a comparable morbidity and mortality with surgical DP, but shorter hospital stays. To aid in the management of these complex disease processes, early consultation of a multidisciplinary management service for these patients should be considered. Furthermore, the appropriate use of LR for infectious etiologies may lead to safer postoperative outcomes than previously thought.
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Affiliation(s)
- Ian C Bostock
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Fariha Sheikh
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Timothy M Millington
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - David J Finley
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Joseph D Phillips
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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20
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Yamada K, Seki Y, Nakagawa T, Hayashi Y, Yagi M, Ogawa K. Outcomes and risk factors after adjuvant surgical treatments for Mycobacterium avium complex lung disease. Gen Thorac Cardiovasc Surg 2018; 67:363-369. [DOI: 10.1007/s11748-018-1029-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/28/2018] [Indexed: 01/15/2023]
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21
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Egyud M, Suzuki K. Post-resection complications: abscesses, empyemas, bronchopleural fistulas. J Thorac Dis 2018; 10:S3408-S3418. [PMID: 30505528 PMCID: PMC6218366 DOI: 10.21037/jtd.2018.08.48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 08/07/2018] [Indexed: 11/06/2022]
Abstract
The role of thoracic surgeons in the management of pulmonary infection has evolved over time as the medical treatments have improved. We herein review historical and current management for surgically-treated pulmonary infections-lung abscesses, empyemas, and bronchopleural fistulas. In particular, we review when the surgeons need to be involved for infectious cases, our algorithm/approach to empyemas, and summary of post-operative bronchopleural fistula in tuberculosis cases.
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Affiliation(s)
- Matthew Egyud
- Department of Surgery, Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Kei Suzuki
- Department of Surgery, Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
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22
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Aznar ML, Zubrinic M, Siemienowicz M, Hashimoto K, Brode SK, Mehrabi M, Patsios D, Keshavjee S, Marras TK. Adjuvant lung resection in the management of nontuberculous mycobacterial lung infection: A retrospective matched cohort study. Respir Med 2018; 142:1-6. [PMID: 30170795 DOI: 10.1016/j.rmed.2018.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/18/2018] [Accepted: 07/07/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Lung resection in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) is considered when medical therapy alone fails to provide long term control. Data regarding comparative and long-term outcomes are limited. We aimed to review indications and outcomes of adjuvant lung resection for NTM-PD compared with controls. METHODS We retrospectively studied 27 surgically treated patients, matched 1:1 for age, sex, NTM species, and radiologic pattern of disease, with control patients treated exclusively with antibiotics. RESULTS In the surgical group, the median (IQR) age was 55 (49-61) years and 74.1% were female. Eighteen patients had Mycobacterium avium complex, and 9 had M. xenopi. Operations included 8 pneumonectomies, 20 lobectomies, one segmentectomy and one lobectomy plus segmentectomy. Post-surgical complications occurred in 6 patients (20%), including 2 acute respiratory distress syndrome, 1 bronchopleural fistula, 1 pericardial tamponade, and 2 empyema. Complications were more common among patients operated upon for progressive disease despite medical therapy (OR 10, p = 0.025). Of 24 matched pairs followed for ≥1 year, sustained culture conversion was observed in 21 (87.5%) patients in the surgical group and in 11 (45.8%) patients in the non-surgical group (RR 2.36, 95%CI 1.37-4.03, p = 0.002). Median (IQR) percentage of follow-up time on antibiotics was 14% (0-100%) in the surgical group and 83% (10.8%-100%) in the non-surgical group (p = 0.195) during a median (IQR) follow-up of 16 (2-36) months. CONCLUSIONS NTM-PD patients who underwent adjuvant lung resection experienced significant morbidity and more frequently achieved sputum culture conversion. Long term antibiotic requirements may have been reduced.
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Affiliation(s)
- María Luisa Aznar
- Division of Respirology, Department of Medicine, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Marijana Zubrinic
- Division of Thoracic Surgery, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G2C4, Canada
| | - Miranda Siemienowicz
- Joint Department of Medical Imaging, University Health Network, Women's College Hospital and Mount Sinai Hospital, Toronto, ON, Canada
| | - Kohei Hashimoto
- Division of Thoracic Surgery, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G2C4, Canada
| | - Sarah Kathleen Brode
- Division of Respirology, Department of Medicine, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada; West Park Healthcare Centre, 82 Buttonwood Ave., Toronto, ON, M6M 2J5, Canada; Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
| | - Mahtab Mehrabi
- Division of Respirology, Department of Medicine, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Demetris Patsios
- Joint Department of Medical Imaging, University Health Network, Women's College Hospital and Mount Sinai Hospital, Toronto, ON, Canada
| | - Shafique Keshavjee
- Division of Thoracic Surgery, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G2C4, Canada
| | - Theodore Konstantine Marras
- Division of Respirology, Department of Medicine, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada; Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada.
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23
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Lopez-Pastorini A, Koryllos A, Schnell J, Galetin T, Defosse J, Schieren M, Ludwig C, Stoelben E. Perioperative outcome after open and thoracoscopic segmentectomy for the treatment of malignant and benign pulmonary lesions: a propensity-matched analysis. J Thorac Dis 2018; 10:3651-3660. [PMID: 30069363 DOI: 10.21037/jtd.2018.05.80] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background The aim of this study was to compare the perioperative outcome of patients receiving anatomic segmentectomy either by open surgery or video-assisted thoracoscopic surgery (VATS). To assess the short-term morbidity of the procedure itself, lung cancer patients in all stages as well as patients with pulmonary metastases and benign lesions scheduled for segmental resection were enrolled in this study. Methods A retrospective analysis of prospectively collected data on 445 consecutive patients that underwent segmentectomy either by VATS (n=233) or thoracotomy (n=212) was performed. A propensity-matched analysis was conducted based on age, gender, smoking history, histology, tumor size, forced expiratory volume in 1 second (FEV1) and history of previous pulmonary resections. The matched sample included two groups of 140 patients each. Results Both study groups were comparable with respect to age, gender, smoking history, diagnosis, tumor size, pulmonary function and history of previous pulmonary resections. VATS segmentectomy was associated with decreased length of stay (7.4 vs. 9.5 days, P<0.001), drainage treatment time (4.7 vs. 5.9 days, P=0.012) and severe postoperative complications (1.4% vs. 7.1%, P=0.018). Conclusions VATS segmentectomy is safe and effective for the treatment of benign and malignant pulmonary lesions. Compared with open thoracotomy, it is associated with shorter hospitalization time and decreased number of severe complications. The preservation of functional lung tissue, combined with a minimally invasive approach, make VATS segmentectomy highly suitable for patients with reduced pulmonary function or severe comorbidities.
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Affiliation(s)
- Alberto Lopez-Pastorini
- Department of Thoracic Surgery, Lung Clinic Merheime, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Aris Koryllos
- Department of Thoracic Surgery, Lung Clinic Merheime, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Jost Schnell
- Department of Thoracic Surgery, Lung Clinic Merheime, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Thomas Galetin
- Department of Thoracic Surgery, Lung Clinic Merheime, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Jérôme Defosse
- Department of Anaesthesiology and Intensive Care Medicine, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Mark Schieren
- Department of Anaesthesiology and Intensive Care Medicine, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Corinna Ludwig
- Department of Thoracic Surgery, Florence Nightingale Hospital, Düsseldorf, Germany
| | - Erich Stoelben
- Department of Thoracic Surgery, Lung Clinic Merheime, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
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24
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Asakura T, Hayakawa N, Hasegawa N, Namkoong H, Takeuchi K, Suzuki S, Ishii M, Betsuyaku T, Abe Y, Ouchi M. Long-term Outcome of Pulmonary Resection for Nontuberculous Mycobacterial Pulmonary Disease. Clin Infect Dis 2018; 65:244-251. [PMID: 28369361 DOI: 10.1093/cid/cix274] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/24/2017] [Indexed: 01/03/2023] Open
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.
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Affiliation(s)
- Takanori Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine.,Japan Society for the Promotion of Science, Tokyo
| | | | - Naoki Hasegawa
- Center for Infectious Diseases and Infection Control, Keio University School of Medicine
| | - Ho Namkoong
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine.,Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan
| | - Ken Takeuchi
- Department of Thoracic Surgery, Seirei Yokohama Hospital, Kanagawa
| | - Shoji Suzuki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine
| | - Tomoko Betsuyaku
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine
| | - Yoshiaki Abe
- Department of Thoracic Surgery, Seirei Yokohama Hospital, Kanagawa
| | - Motofumi Ouchi
- Department of Thoracic Surgery, Seirei Yokohama Hospital, Kanagawa
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25
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Abstract
This article addresses technical details of uniportal VATS segmentectomy by lung segments, suggesting available techniques for lesion localization and identification of the intersegmental plane. Long-term results and superiority have not yet been characterized in standard VATS for lung malignancy. Indications include almost all thoracic procedures currently performed by conventional multiport VATS. We review our experience and published literature on the feasibility of uniportal VATS segmentectomy.
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Affiliation(s)
- Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| | - Kook Nam Han
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
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26
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Sakane T, Matsuoka K, Kumata S, Watanabe R, Yamada T, Matsuoka T, Nagai S, Ueda M, Miyamoto Y. The outcomes of anatomical lung resection for nontuberculous mycobacterial lung disease. J Thorac Dis 2018; 10:954-962. [PMID: 29607168 DOI: 10.21037/jtd.2018.01.60] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The number of cases of nontuberculous mycobacterial (NTM) lung disease has been increasing in recent years, and the efficacy of surgical treatment has been recognized. We investigated the clinical characteristics and behavior of NTM lung disease and analyzed the outcomes of surgery. Methods The data of 25 patients who underwent anatomical resection for NTM lung disease in our institution between January 2004 and December 2014 were retrospectively examined. Results The patients included 10 men and 15 women (mean age, 63.1 years). Twenty patients had Mycobacterium avium, and 5 had Mycobacterium intracellular. The indications for lung resection in 20 definitively diagnosed patients included a remaining or worsening lesion despite medical treatment (n=16), massive hemoptysis or bloody sputum (n=5), and prolonged smear positivity (n=1); multiple reasons were allowed. In five cases without a definitive diagnosis, surgery was performed due to the suspicion of lung cancer. The surgical procedures included pneumonectomy, n=4; lobectomy, n=13; and segmentectomy, n=8. Complete resection was achieved in 10 cases (40.0%). Video-assisted thoracoscopic surgery (VATS) was performed in 17 cases (68.0%), especially in 6 of 8 cases (75.0%) that underwent segmentectomy and in 10 of 11 cases (90.9%) that received simple lobectomy. There was one case of hospital mortality. Among the 22 patients who were followed at our institution, relapse occurred in 4 patients, and new infection occurred in 1 patient. NTM lung disease was controlled in 17 patients (77.3%). In the four cases that relapsed, the median relapse-free interval was 29.5 months. Conclusions Surgical resection was a feasible treatment for NTM lung disease and was associated with favorable outcomes, although there was 1 case of hospital mortality. VATS procedures were considered adequate for the treatment of NTM lung disease; however, the surgical indications must be carefully considered.
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Affiliation(s)
- Tadashi Sakane
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Katsunari Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Sakiko Kumata
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Risa Watanabe
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Tetsu Yamada
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Takahisa Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Shinjiro Nagai
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Mitsuhiro Ueda
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Yoshihiro Miyamoto
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
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27
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Cortés-Julián G, Valencia LC, Ríos-Pascual S, de la Rosa-Abarroa MA, Guzmán-de Alba E. Complications of surgery for infectious lung cavities. Asian Cardiovasc Thorac Ann 2018; 26:120-126. [PMID: 29383943 DOI: 10.1177/0218492318754740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Infectious lung cavities are a common entity for the respiratory physician. Sometimes these lesions require surgical treatment, but surgery is challenging, and complications are common. Methods Patients with infectious lung cavities amenable to surgical treatment were included in a case-control study. The control group included patients with no complications. The cases group comprised patients with any of the following complications up to 90 days after surgery: death, persistence of hemoptysis, empyema, operative blood loss > 500 mL, vascular lesion requiring repair, massive transfusion (>5 units of packed red blood cells per 48 h) or reoperation for bleeding, postoperative mechanical ventilation, intensive care unit stay > 48 h, prolonged air leak, and persistent atelectasis. The potential risk factors for complications analyzed were demographic data, exposure to contaminants, comorbidities, preoperative embolization, surgical indication, spirometry results, and sputum test positive for Mycobacterium tuberculosis. Results Forty-five patients were included in the study and divided into 24 cases and 21 controls. We found a significant difference in the time to removal of chest tubes in favor of the noncomplicated cases (6.45 vs. 4.05 days, p = 0.030), and persistent active infection at the time of surgery tended to be a risk factor for complications (odds ratio = 6.6, 95% confidence interval: 0.7-60, p = 0.061). Conclusion The presence of persistent active infection at the time of surgery could be a risk factor for complications in resection surgery for infectious lung cavities.
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Affiliation(s)
| | - Luis C Valencia
- National Institute of Respiratory Diseases, Mexico City, Mexico
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Abstract
INTRODUCTION The prevalence and awareness of bronchiectasis not related to cystic fibrosis (CF) is increasing and it is now recognized as a major cause of respiratory morbidity, mortality and healthcare utilization worldwide. The need to elucidate the early origins of bronchiectasis is increasingly appreciated and has been identified as an important research priority. Current treatments for pediatric bronchiectasis are limited to antimicrobials, airway clearance techniques and vaccination. Several new drugs targeting airway inflammation are currently in development. Areas covered: Current management of pediatric bronchiectasis, including discussion on therapeutics, non-pharmacological interventions and preventative and surveillance strategies are covered in this review. We describe selected adult and pediatric data on bronchiectasis treatments and briefly discuss emerging therapeutics in the field. Expert commentary: Despite the burden of disease, the number of studies evaluating potential treatments for bronchiectasis in children is extremely low and substantially disproportionate to that for CF. Research into the interactions between early life respiratory tract infections and the developing immune system in children is likely to reveal risk factors for bronchiectasis development and inform future preventative and therapeutic strategies. Tailoring interventions to childhood bronchiectasis is imperative to halt the disease in its origins and improve adult outcomes.
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Affiliation(s)
- Danielle F Wurzel
- a The Royal Children's Hospital , Parkville , Australia.,b Murdoch Childrens Research Institute , Parkville , Australia
| | - Anne B Chang
- c Lady Cilento Children's Hospital , Queensland University of Technology , Brisbane , Australia.,d Menzies School of Health Research , Charles Darwin University , Darwin , Australia
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Yuan P, Cao JL, Huang S, Zhang C, Bao FC, Hu YJ, Lv W, Hu J. Sublobar Resection for Pulmonary Aspergilloma: A Safe Alternative to Lobectomy. Ann Thorac Surg 2017; 103:1788-1794. [DOI: 10.1016/j.athoracsur.2017.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/07/2016] [Accepted: 01/03/2017] [Indexed: 10/19/2022]
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Thirugnanam A. Video-assisted thoracoscopic surgery and open chest surgery in infectious lung diseases. J Vis Surg 2017; 3:3. [PMID: 29078566 DOI: 10.21037/jovs.2016.12.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/22/2016] [Indexed: 11/06/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) for infection or inflammatory conditions is uncommon as compared to lung cancer. In most developed countries less than 5% of all VATS procedures are for infective/inflammatory conditions. However VATS is technically more challenging in this situation and are more prone to postoperative complications. Principles of VATS for infectious diseases involve complete safe surgical removal of the diseased infected lung and prevention of major complications by minimally invasive technique.
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Pan X, Zhang Y, Ren S, Ding Z, Li X, Zhu D, Zhang C, Zhao J. Video-assisted thoracoscopic superior segmentectomy of the right lower lobe. J Thorac Dis 2016; 8:1349-52. [PMID: 27293858 PMCID: PMC4885977 DOI: 10.21037/jtd.2016.04.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 03/31/2016] [Indexed: 11/06/2022]
Abstract
A 61-year-old male patient was referred to the thoracic surgery department due to repeated hemoptysis for more than one year. The computed tomography revealed a 5.2 cm × 3.1 cm mass in the right lower lobe and the nature of the mass was confirmed to be chronic inflammation by trans percutaneous lung biopsy. Bronchiectasis of the right lower lobe was considered based on the symptoms, signs, and imaging findings. Surgery for bronchiectasis is used only as part of a multimodality treatment approach. After the adequate pretreatment with a targeted antimicrobial, thoracoscopic resection of superior segment of the right lower pulmonary lobe was finally performed in the order of the superior segmental artery, the superior segmental vein, the superior segmental bronchus, and the pulmonary tissues of the superior segment. Total surgery time was 70 min and blood loss was 100 mL. The chest tube was removed on the 3(th) postoperative day. The patient was discharged home on the 8(th) postoperative day.
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Pan X, Zhang Y, Li X, Ding Z, Zhu D, Zhang C, Zhao J. Video-assisted thoracoscopic segmentectomy of lingual segment of the left upper pulmonary lobe for chronic focal bronchiectasis. J Thorac Dis 2016; 8:628-30. [PMID: 27076962 DOI: 10.21037/jtd.2016.02.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 46-year-old male patient was admitted into the hospital due to repeated hemoptysis for more than seven months. Bronchiectasis of the left upper lobe was considered based on the symptoms, signs, and imaging findings. Thoracoscopic resection of lingual segment of the left upper pulmonary lobe was finally performed in the order of the lingual segmental vein, the lingual segmental bronchus, the lingual segmental artery, and the pulmonary tissues of the lingual segment. Total surgery time was 60 min and blood loss was 40 mL. The chest tube was removed on the 4th postoperative day. The patient was discharged home on the 8(th) postoperative day.
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Affiliation(s)
- Xue Pan
- 1 The Nursing College of Zhengzhou University, Zhengzhou 450052, China ; 2 Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yan Zhang
- 1 The Nursing College of Zhengzhou University, Zhengzhou 450052, China ; 2 Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xiangnan Li
- 1 The Nursing College of Zhengzhou University, Zhengzhou 450052, China ; 2 Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Zheng Ding
- 1 The Nursing College of Zhengzhou University, Zhengzhou 450052, China ; 2 Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Dengyan Zhu
- 1 The Nursing College of Zhengzhou University, Zhengzhou 450052, China ; 2 Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Chunyang Zhang
- 1 The Nursing College of Zhengzhou University, Zhengzhou 450052, China ; 2 Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Jia Zhao
- 1 The Nursing College of Zhengzhou University, Zhengzhou 450052, China ; 2 Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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ElMaraachli W, Conrad DJ, Wang ACC. Using Cystic Fibrosis Therapies for Non-Cystic Fibrosis Bronchiectasis. Clin Chest Med 2015; 37:139-46. [PMID: 26857775 DOI: 10.1016/j.ccm.2015.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Non-cystic fibrosis bronchiectasis (NCFB) is an increasingly prevalent disease that places a significant burden on patients and health systems globally. Although many of the therapies used to treat NCFB were originally developed as cystic fibrosis (CF) therapies, not all of them have been demonstrated to be efficacious in NCFB and some may even be harmful. This article explores the evidence for which therapeutic strategies used to treat CF have been translated into the care of NCFB. The conclusion is that therapies for adult NCFB cannot be simply extrapolated from CF clinical trials, and in some instances, doing so may actually result in harm.
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Affiliation(s)
- Wael ElMaraachli
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, 200 West Arbor Drive, MC 8372, San Diego, CA 92013, USA
| | - Douglas J Conrad
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, 200 West Arbor Drive, MC 8372, San Diego, CA 92013, USA.
| | - Angela C C Wang
- Division of Chest and Critical Care Medicine, Scripps Clinic, 10666 North Torrey Pines Road, W203, San Diego, CA 92037, USA
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Novosad S, Henkle E, Winthrop KL. The Challenge of Pulmonary Nontuberculous Mycobacterial Infection. CURRENT PULMONOLOGY REPORTS 2015; 4:152-161. [PMID: 26877911 DOI: 10.1007/s13665-015-0119-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The incidence of nontuberculous mycobacterial (NTM) lung disease is increasing. Current treatment strategies are largely based on expert opinion. The lack of randomized clinical trials to inform treatment leave clinicians with many questions regarding the most effective and safe regimens. The risk-benefit ratio of therapy is often thought to favor observation given the chronic nature of the disease, multiple long-term antibiotics recommended for therapy, side effects associated with treatment, and perceived lack of efficacious therapies.
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Affiliation(s)
- Shannon Novosad
- Pulmonary & Critical Care Medicine Oregon Health & Science University 3181 SW Sam Jackson Park Road, UHN 67 Portland, OR, 97239 USA
| | - Emily Henkle
- School of medicine Public Health & Preventive Medicine Oregon Health & Science University 3181 SW Sam Jackson Park Road Portland, OR, 97239 USA
| | - Kevin L Winthrop
- Department of Medicine Division of Infectious Diseases Oregon Health & Science University 3181 SW Sam Jackson Park Road Portland, OR, 97239 USA
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Kang HK, Park HY, Kim D, Jeong BH, Jeon K, Cho JH, Kim HK, Choi YS, Kim J, Koh WJ. Treatment outcomes of adjuvant resectional surgery for nontuberculous mycobacterial lung disease. BMC Infect Dis 2015; 15:76. [PMID: 25887191 PMCID: PMC4342798 DOI: 10.1186/s12879-015-0823-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 02/10/2015] [Indexed: 01/15/2023] Open
Abstract
Background Outcomes of antibiotic treatment for lung disease caused by nontuberculous mycobacteria (NTM) are unsatisfactory. The role of adjunctive surgery in the treatment of NTM lung disease is still unclear. Methods We conducted a retrospective review of 70 patients who underwent pulmonary resection for NTM lung disease from March 2007 to February 2013. All patients received recommended antibiotic treatment before and after the surgery. Results A total of 70 patients underwent 74 operations. The median age of the patients was 50 years. Of the 70 patients, 45 (64%) had Mycobacterium avium complex infection (24 M. intracellulare and 21 M. avium) and 23 (33%) had M. abscessus complex infection (15 M. abscessus and 8 M. massiliense). Thirty-eight (54%) patients had the nodular bronchiectatic form and 28 (40%) had the fibrocavitary form of NTM lung disease. The indications for surgery were a poor response to drug therapy (n=52), remnant cavitary lesions and severe bronchiectasis (n=14), and hemoptysis (n=4). Preoperative sputum acid-fast bacilli staining results were positive in 44 (63%) patients, and sputum culture was positive in 54 (76%). The surgery included lobectomy or lobectomy plus segmentectomy (n=50, 68%), segmentectomy (n=11, 15%), pneumonectomy or completion pneumonectomy (n=8, 11%), bilobectomy or bilobectomy plus segmentectomy (n=4, 5%), and wedge resection (n=1, 1%). Postoperative complications occurred in 15 (21%) patients, including one postoperative death and bronchopleural fistula in 5 patients with the fibrocavitary form of the disease. A negative sputum culture was achieved and maintained in 57 (81%) patients. Conclusions Although adjuvant pulmonary resection is associated with a relatively high complication rate, this procedure may provide a high level of treatment success for selected patients with NTM lung disease, such as those with a poor response to antibiotic treatment alone.
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Affiliation(s)
- Hyung Koo Kang
- Departments of Medicine, Division of Pulmonary and Critical Care Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Hye Yun Park
- Departments of Medicine, Division of Pulmonary and Critical Care Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Dohun Kim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. .,Department of Thoracic Surgery, Chungbuk National University Hospital, Cheongju, Chungbuk, South Korea.
| | - Byeong-Ho Jeong
- Departments of Medicine, Division of Pulmonary and Critical Care Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Kyeongman Jeon
- Departments of Medicine, Division of Pulmonary and Critical Care Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Jong Ho Cho
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Hong Kwan Kim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Yong Soo Choi
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Jhingook Kim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Won-Jung Koh
- Departments of Medicine, Division of Pulmonary and Critical Care Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Abstract
The incidence of pulmonary nontuberculous mycobacterial disease is increasing. Despite aggressive medical therapy, a subset of patients will experience treatment failure or suffer disabling or life-threatening symptoms. The use of anatomic lung resection in addition to optimal medical management may, in select cases, result in improved clinical outcomes. More data are needed to confirm this approach. For those with nontuberculous mycobacterial infection, treatment in a multidisciplinary setting including surgeons familiar with operative techniques specific to infectious lung disease will improve patient care.
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Affiliation(s)
- John D Mitchell
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, C-310, 12631 East 17th Avenue, Aurora, CO 80045, USA.
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Sun Y, Hou L, Xie H, Zheng H, Jiang G, Gao W, Chen C. Wedge resection for localized infectious lesions: high margin/lesion ratio guaranteed operational safety. J Thorac Dis 2014; 6:1173-9. [PMID: 25276357 DOI: 10.3978/j.issn.2072-1439.2014.08.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 07/25/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aims to elucidate the risk factors of pulmonary complications for localized infectious lesions with limited resection. METHODS We retrospectively investigated 139 cases for which wedge resection had been performed for localized pulmonary infectious lesions. Patients included 85 males and 54 females with a median age of 53 years (range: 21-74 years old). Forty-six patients had focal organizing pneumonia (OP), sixty patients had lung abscess, twenty-three patients had aspergilloma, five patients had lung abscess combining aspergillus fumigatus, and five patients had lung abscess combined with tuberculosis granuloma. Information regarding perioperative manipulations, surgical complications, and follow-ups were collected for further analysis. RESULTS Prominent pneumonia developed in eight cases post-operation. In follow-up, one patient had a recurrence of lung abscess five months post-operation and underwent a left upper lobectomy and one patient died two months after discharge because of respiratory failure that resulted from pneumonia. Univariate and multivariate analysis showed a significant difference in the margin/lesion ratio (distance between staple margins to lesion/the maximum tumor diameter) between patients with pulmonary complications and those without complications (P=0.01). The best cut-off value of margin/lesion ratio to complication was 0.985, and a margin/lesion ratio less than 0.985 was associated with high post-operative complications. CONCLUSIONS The present case series shows that partial resection for localized pulmonary infection is an acceptable surgical manipulation. A high margin/lesion ratio achievement may guarantee operational safety.
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Affiliation(s)
- Yifeng Sun
- 1 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital Affiliated Shanghai Jiaotong University, Shanghai 200030, China ; 3 Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Likun Hou
- 1 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital Affiliated Shanghai Jiaotong University, Shanghai 200030, China ; 3 Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Huikang Xie
- 1 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital Affiliated Shanghai Jiaotong University, Shanghai 200030, China ; 3 Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Hui Zheng
- 1 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital Affiliated Shanghai Jiaotong University, Shanghai 200030, China ; 3 Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Gening Jiang
- 1 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital Affiliated Shanghai Jiaotong University, Shanghai 200030, China ; 3 Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Wen Gao
- 1 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital Affiliated Shanghai Jiaotong University, Shanghai 200030, China ; 3 Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Chang Chen
- 1 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital Affiliated Shanghai Jiaotong University, Shanghai 200030, China ; 3 Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Affiliation(s)
- Ricardo J José
- Wellcome Trust Clinical Research Fellow in the Centre for Inflammation and Tissue Repair, University College London, London WC1E 6JF and Honorary Specialist Registrar in the Department of Thoracic Medicine, University College London Hospital, London
| | - Jeremy S Brown
- Professor of Respiratory Infection, Centre for Inflammation and Tissue Repair, University College London, London, and Consultant Respiratory Physician, Department of Thoracic Medicine, University College London Hospital, London
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Lung Resection Improves the Quality of Life of Patients With Symptomatic Bronchiectasis. Ann Thorac Surg 2014; 98:1034-41. [DOI: 10.1016/j.athoracsur.2014.04.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 04/02/2014] [Accepted: 04/04/2014] [Indexed: 11/18/2022]
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Nontuberculous mycobacteria: the changing epidemiology and treatment challenges in cystic fibrosis. Curr Opin Pulm Med 2014; 19:662-9. [PMID: 24048085 DOI: 10.1097/mcp.0b013e328365ab33] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Although patients with cystic fibrosis (CF) face numerous infectious pathogens over the course of their lifespan, increasing attention has recently been paid to nontuberculous mycobacteria (NTM). As reported prevalence rates rise across many countries such as the United States, the ability to recognize disease caused by NTM and subsequently treat such disease has become increasingly important. This review summarizes new observations on the epidemiology of NTM in CF as well as key elements to consider during the treatment phase. RECENT FINDINGS Although overall rates of NTM isolation appear to be increasing, particular concern has focused on the emerging predominance of Mycobacterium abscessus. New data suggest that chronic macrolide therapy now part of routine CF care has contributed to this rise; however, these have yet to be confirmed prospectively. Transmission of M. abscessus between CF patients has also now been described through the use of genome sequencing. Although the greater virulence of M. abscessus makes it a challenging species to treat, identification of the subspecies type can now determine the presence of inducible macrolide resistance, thereby helping to guide treatment. SUMMARY Given increasing prevalence rates, clinicians should maintain a high level of suspicion for NTM as disease-causing organisms in CF, particularly for M. abscessus. New knowledge regarding this species, however, can help to tailor appropriate therapy.
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Shiraishi Y. Surgical treatment of nontuberculous mycobacterial lung disease. Gen Thorac Cardiovasc Surg 2014; 62:475-80. [DOI: 10.1007/s11748-014-0402-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Indexed: 10/25/2022]
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Matsuoka K, Imanishi N, Matsuoka T, Nagai S, Ueda M, Miyamoto Y. Video-assisted thoracoscopic surgery for nontuberculous mycobacterial infection. Asian Cardiovasc Thorac Ann 2014; 22:1066-71. [PMID: 24622645 DOI: 10.1177/0218492314527594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The number of patients with nontuberculous mycobacterium infection is increasing in Japan, and therefore surgical treatment is also being applied with increasing frequency. Although the effectiveness of surgery for nontuberculous mycobacterium disease has been established and reported by a number of authors, the role of video-assisted thoracoscopic surgery in the surgical treatment of nontuberculous mycobacterium disease has not been sufficiently investigated. PATIENTS AND METHODS We retrospectively investigated 10 patients, comprising 5 males and 5 females, who underwent video-assisted thoracoscopic lobectomy or segmentectomy for nontuberculous mycobacterium disease at our institution between February 2006 and November 2012. The average patient age was 59.5 years (range 53-65 years). We performed lobectomy in 6 cases and segmentectomy in 4. RESULTS All surgical procedures were completed under video-assisted thoracoscopic surgery and none required conversion to thoracotomy. Postoperatively, air leakage continuing for 7 days occurred in 2 patients but there was no severe postoperative complication. The median periods of postoperative drainage and hospitalization were 4.0 and 5.5 days, respectively. Among 8 cases followed up at our institution, reactivation of nontuberculous mycobacterium disease occurred in one case 4 years after surgery. CONCLUSION Video-assisted thoracoscopic surgery is a safe and useful procedure for lobectomy and segmentectomy in patients with nontuberculous mycobacterium disease.
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Affiliation(s)
- Katsunari Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji City, Japan
| | - Naoko Imanishi
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji City, Japan
| | - Takahisa Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji City, Japan
| | - Shinjiro Nagai
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji City, Japan
| | - Mitsuhiro Ueda
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji City, Japan
| | - Yoshihiro Miyamoto
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji City, Japan
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Nontuberculous mycobacterial (NTM) lung disease: The top ten essentials. Respir Med 2014; 108:417-25. [DOI: 10.1016/j.rmed.2013.09.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 08/13/2013] [Accepted: 09/16/2013] [Indexed: 11/19/2022]
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45
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Mitchell JD. Techniques of VATS lobectomy. J Thorac Dis 2013; 5 Suppl 3:S177-81. [PMID: 24040520 DOI: 10.3978/j.issn.2072-1439.2013.07.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 07/15/2013] [Indexed: 11/14/2022]
Affiliation(s)
- John D Mitchell
- General Thoracic Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
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McShane PJ, Naureckas ET, Tino G, Strek ME. Non–Cystic Fibrosis Bronchiectasis. Am J Respir Crit Care Med 2013; 188:647-56. [DOI: 10.1164/rccm.201303-0411ci] [Citation(s) in RCA: 260] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Shiraishi Y, Katsuragi N, Kita H, Hyogotani A, Saito MH, Shimoda K. Adjuvant surgical treatment of nontuberculous mycobacterial lung disease. Ann Thorac Surg 2013; 96:287-91. [PMID: 23618520 DOI: 10.1016/j.athoracsur.2013.03.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 02/21/2013] [Accepted: 03/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND According to the 2007 American Thoracic Society/Infectious Diseases Society of America statement on nontuberculous mycobacterial diseases, more evidence for the benefits of adjuvant nontuberculous mycobacterial lung disease surgical intervention is needed before its wide application can be recommended. METHODS A retrospective review was conducted of 60 consecutive patients who met American Thoracic Society/Infectious Diseases Society of America diagnostic criteria and underwent pulmonary resection for localized nontuberculous mycobacterial lung disease between January 2007 and December 2011. All patients were receiving chemotherapy before resection. RESULTS Included were 41 women (68%) and 19 men (32%), with a median age of 50 years (range, 20 to 72 years). Of these, 55 patients (92%) had Mycobacterium avium complex disease. Bronchiectatic disease was noted in 29 patients, cavitary disease in 25, both in 4, and nodular disease in 2. The indications for resection were a poor response to drug therapy in 52 patients, hemoptysis in 6, and a secondary infection in 2. Sixty-five pulmonary resections were performed: 1 pneumonectomy, 3 bilobectomies, 39 lobectomies, 17 segmentectomies, 3 lobectomies plus segmentectomies, and 2 wedge resections. There were no operative deaths, and all patients attained sputum-negative status postoperatively. Eleven postoperative complications occurred in 8 patients (12%); relapse was observed in only 2 (3%). CONCLUSIONS Pulmonary resection combined with chemotherapy is safe, with favorable treatment outcomes, for patients with localized nontuberculous mycobacterial lung disease. Our results support the liberal use of operations for nontuberculous mycobacterial lung disease whenever indicated.
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Affiliation(s)
- Yuji Shiraishi
- Section of Chest Surgery, Fukujuji Hospital, Kiyose, Tokyo, Japan.
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Abstract
Surgical evaluation in nontuberculous mycobacterial (NTM) infections plays an essential role as part of multidisciplinary management of this complex pulmonary process. Resection of damaged lung parenchyma combined with appropriate antimicrobial therapy may interrupt a cycle of disease progression and relapse in select patients. Relevant technical considerations for managing both minimally invasive and open anatomic resection in this unique population are discussed. Results of anatomic resection of NTM damaged lung in the modern era are also summarized.
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Affiliation(s)
- Jessica A Yu
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, 12631 East 17th Avenue, C310, Aurora, CO 80045, USA
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Massard G, Olland A, Santelmo N, Falcoz PE. Surgery for the Sequelae of Postprimary Tuberculosis. Thorac Surg Clin 2012; 22:287-300. [DOI: 10.1016/j.thorsurg.2012.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mauchley DC, Daley CL, Iseman MD, Mitchell JD. Pulmonary Resection and Lung Transplantation for Bronchiectasis. Clin Chest Med 2012; 33:387-96. [DOI: 10.1016/j.ccm.2012.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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