Abstract
Invasive pulmonary aspergillosis (IPA) is one of the most severe infections in immunocompromised patients. In the 90's, surgery was considered a potentially curative treatment. Since voriconazole has become the first line treatment, the role of surgery has not been evaluated.
Thirty immunocompromised patients who underwent surgery for a suspected IPA between 1990 and 2010 were retrospectively reviewed and separated into two groups: the group A (n=20) who received amphotericin B or itraconazole before the surgery, and the group B (n=10) treated by voriconazole.
The diagnosis of IPA before surgery was certain or probable for 60% of the patients. The main indications for surgery were: the resection of a persistent pulmonary lesion prior to subsequent immunosuppressive treatments (50%), incomplete control of the infection (43%), and risk of haemoptysis (10%). The median duration of antifungal treatment before surgery was 1.3 months in the group A, and 2.5 months in the group B (p=0.2). Persisting aspergillosis was confirmed for 85% among the patients from the group A, and only 20% of the group B (p<0.001). Anatomopathogical study provided an alternative diagnosis for 4 patients, all in the group B: 2 mucormycosis, 1 mycobacterial infection, 1 specific lesion of the leukemia. Perioperative mortality was low (3%).
Surgery is a therapeutic option for IPA with low mortality in a well trained surgical team. In the voriconazole era, the proportion of resected pulmonary lesions containing Aspergillus appears to be decreasing, whereas other fungal infections are detected. The role of surgery has to be defined in patients previously treated with voriconazole, particularly for remaining pulmonary lesions.
- © 2012 ERS
