Original Articles
Surgical aspects of resection for suspected invasive pulmonary fungal infection in neutropenic patients

https://doi.org/10.1016/S0003-4975(99)00513-5Get rights and content

Abstract

Background. Morbidity and mortality of early resection of invasive pulmonary fungal disease in neutropenic patients are still considered prohibitive for surgical treatment.

Methods. We retrospectively analyzed results of 28 (16 men, 12 women; mean age, 38.9 years) consecutive neutropenic hematologic patients who had lung resections for suspicion of invasive pulmonary fungal disease.

Results. We did 28 lung resections (19 lobectomies, one bilobectomy, eight single or multiple wedge resections including three video-assisted wedge resections). The disease was proved histologically in 22 (78.6%) cases. Intraoperative difficulties, such as diffuse oozing or mycotic infiltration, and solid postinflammatory adhesions were encountered in 5 (17.8%) and 6 (21.4%) patients respectively. In one case (3.6%) it lead to a major intraoperative hemorrhage. There were no intraoperative deaths, overall 30-day mortality rate was two of 28 (7.1%), overall 90-day mortality rate was seven of 28 (25%), with one death (3.6%) possibly related to surgery. Minor surgery-related complications were seen in ten (35.7%) cases, major surgery-related complications occurred in three (10.7%) cases. Twelve of 22 patients (54.5%) with proven invasive fungal infection are currently alive (mean follow-up, 32.3 months).

Conclusions. Surgery-related complications and mortality are acceptable for this high risk group of patients. Resection should be carried out early for diagnostic as well as therapeutic reasons.

Section snippets

Patients and methods

Between January 1983 and December 1997, 28 consecutive patients (16 men and 12 women; mean age, 38.9 years; range, 9 to 68 years) had pulmonary resection for suspicion of invasive pulmonary aspergillosis. The underlying disease was leukemia (mainly acute and chronic myeloid) in 19 cases, severe aplastic anemia in 7 cases, and myelodysplastic syndrome and Non-Hodgkin’s lymphoma in 1 case each. Treatment before clinical development of pulmonary disease had been high-dose chemotherapy in 18

Intraoperative difficulties and complications

No anesthesiologic complications were observed, ie, no major bleeding episodes from invasive monitoring, central venous and arterial catheters, or from single- or double-lumen intubation. During operation, conspicuous diffuse oozing leading to prolonged hemostasis was noted in 5 cases (17.8%), rendering dissection difficult when combined with inflammatory adhesions and scar tissue adjacent to mycotic lesions. Adhesions and inflammatory tissue near hilar structures and fissures were a major

Comment

Pulmonary aspergillosis is classified into allergic, invasive, and saprophytic infections [14]. Most authors who surgically treated pulmonary aspergillosis in the 1970s and 1980s 15, 16, 17 reported on the saprophytic forms colonizing preexisting lung cavities. Whereas the perioperative mortality rate was low in simple aspergilloma, the mortality rate in complex saprophytic forms was as high as 34%, and complications occurred in up to 78% of these cases, including empyema, prolonged air leak

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