Original ArticlesSurgical aspects of resection for suspected invasive pulmonary fungal infection in neutropenic patients
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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Cited by (27)
Lung resection in hematologic patients with pulmonary invasive fungal disease
2012, ChestCitation Excerpt :Given that many patients need further chemotherapy or stem cell or bone marrow transplantation to cure their underlying hematologic disease, a complete clearance of pulmonary IFD is recommended. Positive experiences with lung resections in the case of IFD have been reported in smaller series.7,12,14,20–29 The majority of the present patients had a normal lung function.
Successful Surgical Management of Invasive Aspergillosis of the Pulmonary Arteries
2008, Annals of Thoracic SurgeryAspergillus pulmonary infections in transplant recipients
2005, Clinics in Chest MedicinePredicting outcome after lung resection for invasive pulmonary aspergillosis in patients with neutropenia
2004, ChestCitation Excerpt :Combining medical treatment and lung resection is controversial, and is done at only a few centers. However, some studies910111213141718 have shown that lung resection in these high-risk patients is feasible with a remarkably low morbidity and mortality: the 30-day mortality ranges from 0% in smaller series, to 31% in larger series. Our patients showed a 30-day mortality of 10%; two patients died due to bacterial septicemia, and two patients died probably as a result of relapsing aspergillosis under persistent neutropenia.
Full thoracoscopic approach for surgical management of invasive pulmonary aspergillosis
2002, Annals of Thoracic SurgeryCitation Excerpt :2) Dense inflammation and hazardous vascular dissection may require assistance of a mini-thoracotomy, or even conversion to a standard thoracotomy. ( 3) Some deeply located lesions are better managed by a segmentectomy [2, 4, 5] than by a wedge resection. In these cases, a thoracotomy may be more appropriate.