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

Abstract

BACKGROUND:

The purpose of this study was to demonstrate our surgical experience for focal bronchiectasis in the setting of modern diagnostic modalities and state-of-the-art medical treatment in a developed country.

METHODS:

Thirty-one patients undergoing 33 lung resections for the treatment of focal bronchiectasis from 1991 to 2009 were reviewed. The mean age was 54 years. Twenty-nine patients (94%) were female; 21 patients (68%) had nontuberculous mycobacterial infection; and 22 patients (71%) received preoperative multiple-drug regimens containing clarithromycin. Five patients (16%) were in an immunocompromised status. All were diagnosed by chest computed tomography scan, and either the right middle lobe or left lingula were involved in 29 (94%). The curve for relapse-free interval was estimated by Kaplan-Meier methods. The factors that affected this curve were examined using Cox's regression analysis.

RESULTS:

Operative morbidity and mortality were 18% and 0%, respectively. All patients became asymptomatic postoperatively. During the median follow-up of 48 months (11 to 216), 8 patients (26%) experienced recurrence, and the mean relapse-free interval was 34 months (3 to 216). By univariate analysis, an immunocompromised status (p=0.017), Pseudomonas aeruginosa infection (p=0.040), the preoperative extent of bronchiectatic lesion (p=0.013), and the extent of residual bronchiectasis after surgery (p=0.003) were significantly associated with the shorter relapse-free interval. By multivariate analysis, an immunocompromised status (p=0.039), Pseudomonas aeruginosa infection (p=0.033), and the extent of residual bronchiectasis (p=0.009) were independent and significant factors.

CONCLUSIONS:

Complete resection of bronchiectasis while the disease is localized and is free from Pseudomonas aeruginosa infection is the key for a success. Also, immunocompromised status was suggested to be a risk factor.

• Authors: Miyako Hiramatsu, Yuji Shiraishi, Yutsuki Nakajima, Etsuo Miyaoka, Naoya Katsuragi, Hidefumi Kita, Akira Hyogotani, Kiyomi Shimoda
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 93 Issue 1 Pg. 245-50 (Jan 2012) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 22119119 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Bronchiectasis (diagnosis, mortality, surgery)
• Developed Countries
• Female
• Follow-Up Studies
• Humans
• Japan (epidemiology)
• Male
• Middle Aged
• Morbidity (trends)
• Pneumonectomy (methods, mortality)
• Postoperative Complications (epidemiology)
• Retrospective Studies
• Risk Factors
• Survival Rate (trends)
• Treatment Outcome