Risk factors that affect the surgical outcome in the management of focal bronchiectasis in a developed country

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Abstract

The purpose of this study was to demonstrate our surgical experience for focal bronchiectasis in the setting of modern diagnostic modalities and state-of-the-art medical treatment in a developed country. Thirty-one patients undergoing 33 lung resections for the treatment of focal bronchiectasis from 1991 to 2009 were reviewed. The mean age was 54 years. Twenty-nine patients (94%) were female; 21 patients (68%) had nontuberculous mycobacterial infection; and 22 patients (71%) received preoperative multiple-drug regimens containing clarithromycin. Five patients (16%) were in an immunocompromised status. All were diagnosed by chest computed tomography scan, and either the right middle lobe or left lingula were involved in 29 (94%). The curve for relapse-free interval was estimated by Kaplan-Meier methods. The factors that affected this curve were examined using Cox's regression analysis. Operative morbidity and mortality were 18% and 0%, respectively. All patients became asymptomatic postoperatively. During the median follow-up of 48 months (11 to 216), 8 patients (26%) experienced recurrence, and the mean relapse-free interval was 34 months (3 to 216). By univariate analysis, an immunocompromised status (p = 0.017), Pseudomonas aeruginosa infection (p = 0.040), the preoperative extent of bronchiectatic lesion (p = 0.013), and the extent of residual bronchiectasis after surgery (p = 0.003) were significantly associated with the shorter relapse-free interval. By multivariate analysis, an immunocompromised status (p = 0.039), Pseudomonas aeruginosa infection (p = 0.033), and the extent of residual bronchiectasis (p = 0.009) were independent and significant factors. Complete resection of bronchiectasis while the disease is localized and is free from Pseudomonas aeruginosa infection is the key for a success. Also, immunocompromised status was suggested to be a risk factor. © 2012 The Society of Thoracic Surgeons.

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Hiramatsu, M., Shiraishi, Y., Nakajima, Y., Miyaoka, E., Katsuragi, N., Kita, H., … Shimoda, K. (2012). Risk factors that affect the surgical outcome in the management of focal bronchiectasis in a developed country. Annals of Thoracic Surgery, 93(1), 245–250. https://doi.org/10.1016/j.athoracsur.2011.08.077

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