Robotic surgical resection in pulmonary nontuberculous mycobacterial disease

SESSION TITLE: Chest Infections Posters 4 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Non-tuberculous mycobacterium pulmonary disease (NTM-PD) is a condition of progressive lung destruction where treatment involves complex medication protocols with numerous toxicities greatly affecting quality of life. In our previous data robotic surgery was shown to be a promising adjunct to therapy for those with localized or refractory disease to decrease symptom burden and hasten cure. This review involves a larger cohort and updated outcomes. METHODS: A retrospective review of patients with NTM–PD who underwent robotic surgical lung resection from August 2017–February 2023 performed by a single experienced surgeon was conducted. RESULTS: A total of 24 patients who underwent 27 procedures were reviewed. Eighty three percent of patients were female and 79% were white. All patients were on antibiotics prior to surgery with 79% of patients receiving IV antibiotics pre-operatively. Indications for surgery included cavitary disease, failure of medical therapy and hemoptysis. The most common procedure performed was a lobectomy followed by segmentectomy. In our center patients are routinely discharged home with chest tube drainage systems. Median length of stay post operatively was 1 day and median chest tube removal occurred on post-operative day 2. Average follow up was 19.9 months (range of 0.23 – 49.9 months) with 2 patients lost to follow up. 10 patients experienced culture conversion following surgery and remained culture negative for at least 1 year leading to antimicrobial therapy discontinuation. Complications included 5 air leaks lasting more than 5 days, 1 post operative effusion requiring thoracentesis, 1 patient with bronchial dehiscence almost 3 months post operatively, and 1 patient who developed acute hypoxic respiratory failure 5 days post operatively. The latter 2 patients died. CONCLUSIONS: Robotic surgical lung resection has minimal recovery time, low serious complication risk and increases the rate of sputum culture conversion in patients who previously failed medical therapy and/or had cavitary disease. The 2 deaths in this review included a patient with extensive macrolide resistant MAI pulmonary disease who had failed all other options. The second was discharged and returned with hypoxic respiratory failure secondary to multifocal pneumonia and opted out of resuscitative efforts including intubation. Profound dysphagia and a massive aspiration event contributed to progressive respiratory failure and death 3 weeks post operatively. These two events highlight that early surgical referral and appropriate patient selection is critical to avoid complications. CLINICAL IMPLICATIONS: Patients with NTM-PD require over a year of antimicrobial treatments with courses often extended in those with cavitary or refractory disease. The longer treatment courses are associated with increased toxicity risk and despite appropriate antimicrobial treatment cure only occurs in 60% of patients with extremely high rates of recurrence. This is partially due to the repository of mycobacterium remaining in the lung. Early surgical intervention via robotic approach is an effective treatment option in appropriately selected patients to increase the likelihood of culture conversion by decreasing disease burden. Further longitudinal follow up is needed to better ascertain cure and relapse rates. DISCLOSURES: PI for a clinical trial; relationship with AN2 Please note: 2021 to present Added 11/13/2022 by Doreen Addrizzo-Harris, source=Web Response, value=Grant/Research Support PI of research trial relationship with Boehringer Please note: 2022-2023 Added 04/01/2023 by Doreen Addrizzo-Harris, value=funds to my institution PI for research grant relationship with Zambone Please note: 2018-2021 by Doreen Addrizzo-Harris, value=funds to my institution PI for research trial relationship with Hill-Rom Please note: 2019-2023 Added 04/01/2023 by Doreen Addrizzo-Harris, value=funds to my institution Clinical Trial, I am PI relationship with Insmed Please note: 2017-2023 Added 04/01/2023 by Doreen Addrizzo-Harris, value=funds to my institution Consultant relationship with Physio-Assist Please note: 2021 Added 11/04/2022 by Ashwin Basavaraj, source=Web Response, value=Consulting fee Consultant relationship with Zambon Please note: 2021 Added 11/04/2022 by Ashwin Basavaraj, source=Web Response, value=Consulting fee Consultant relationship with Dymedso Please note: 2021 Added 11/04/2022 by Ashwin Basavaraj, source=Web Response, value=Consulting fee Advisory Board, PI in clinical study relationship with Hill-Rom Please note: 2019-present Added 11/04/2022 by Ashwin Basavaraj, source=Web Response, value=Consulting fee Advisory Board relationship with Insmed Please note: 2018-present Added 11/04/2022 by Ashwin Basavaraj, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Zambon Please note: 2021 Added 10/24/2022 by Ashwin Basavaraj, source=Web Response, value=Consulting fee Principal investigator in clinical trial relationship with Baxter Please note: 2020-present Added 10/24/2022 by Ashwin Basavaraj, source=Web Response, value=Consulting fee Consultant relationship with Insmed Please note: 2018-present Added 10/24/2022 by Ashwin Basavaraj, source=Web Response, value=Consulting fee No relevant relationships by robert james cerfolio No relevant relationships by Carina Iskandir No relevant relationships by David Kamelhar No relevant relationships by Erin McGuire