• Joong-Yub Kim, Hyun Woo Lee, Jae-Joon Yim, and Nakwon Kwak.
• Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
• Chest. 2023 Apr 1; 163 (4): 763777763-777.

BackgroundThe burden of nontuberculous mycobacterial pulmonary disease (NTM-PD) is increasing worldwide. Amidst the poor treatment success of antibiotic therapy, adjunctive surgery is gaining attention; however, discrepancies in reported outcomes exist.Research QuestionWhat are the treatment outcomes and complications of patients with NTM-PD undergoing adjunctive surgery?Study Design And MethodsThe MEDLINE, Embase, and Cochrane databases were searched for eligible studies before January 2022. Studies reporting the outcomes of adjunctive surgery in adult patients who satisfied the diagnostic criteria for NTM-PD were included. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Data were extracted by two independent observers. Estimates of proportion were pooled using a random-effects model. Sputum mycobacterial culture negative conversion, recurrence, complications, and in-hospital mortality after surgery were primary outcomes that had been set before data collection began. Heterogeneity was evaluated by using the I2 statistic, and publication bias was assessed by using funnel plots and the Egger test.ResultsFifteen of the 2,739 screened studies, with 1,071 patients, were assessed. The weighted proportion of postoperative sputum culture negative conversion was 93% (95% CI, 87%-97%), and recurrence was 9% (95% CI, 6%-14%) for a median follow-up of 34 months. The proportion of patients who experienced postoperative complications was 17% (95% CI, 13%-23%), and in-hospital mortality was 0% (95% CI, 0%-2%). Studies that performed multilobar lung resection in > 30% of the study population showed comparable rates of complications with studies that did not.InterpretationAdjunctive surgery is an effective therapeutic option with acceptable rates of complications for selected patients with NTM-PD.Trial RegistryPROSPERO; No.: CRD42022310663; URL: https://www.crd.york.ac.uk/prospero/.Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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