Lung resection in hematologic patients with pulmonary invasive fungal disease.
- Nebiker CA Division of Thoracic Surgery, University Hospital Basel, Basel, Switzerland. Electronic address: nebikerc@uhbs.ch.
- Lardinois D Division of Thoracic Surgery, University Hospital Basel, Basel, Switzerland.
- Junker L Division of Pneumology, University Hospital Basel, Basel, Switzerland.
- Gambazzi F Division of Thoracic Surgery, University Hospital Basel, Basel, Switzerland.
- Matt P Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
- Habicht JM Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
- Halter J Division of Hematology, University Hospital Basel, Basel, Switzerland.
- Heim D Division of Hematology, University Hospital Basel, Basel, Switzerland.
- Stern M Division of Hematology, University Hospital Basel, Basel, Switzerland.
- Buser AS Division of Hematology, University Hospital Basel, Basel, Switzerland.
- Passweg J Division of Hematology, University Hospital Basel, Basel, Switzerland.
- Stolz D Division of Pneumology, University Hospital Basel, Basel, Switzerland.
- Flückiger UM Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
- Weisser M Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
- Battegay M Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
- Bubendorf L Department of Pathology, University Hospital Basel, Basel, Switzerland.
- Gratwohl A Division of Hematology, University Hospital Basel, Basel, Switzerland.
- Tamm M Division of Pneumology, University Hospital Basel, Basel, Switzerland.
- 2012-03-31
Published in:
- Chest. - 2012
Adolescent
Adult
Aged
Antifungal Agents
Aspergillosis
Child
Combined Modality Therapy
Female
Follow-Up Studies
Hematologic Neoplasms
Humans
Immunocompromised Host
Lung
Lung Diseases, Fungal
Male
Middle Aged
Pneumonectomy
Prognosis
Retrospective Studies
Survival Rate
Switzerland
Young Adult
English
BACKGROUND
Pulmonary invasive fungal disease is a frequent complication in patients with hematologic malignancies. Surgical resection in addition to antifungal therapy is an option for selected cases but often feared because of immunosuppression.
METHODS
We analyzed the outcome of 71 patients undergoing lung resection for pulmonary invasive fungal disease. Most patients had leukemia, 44 underwent high-dose chemotherapy, and 18 underwent stem cell transplantation.
RESULTS
On the day of surgery, 44 patients were neutropenic, and 41 had a platelet count < 50 × 109/L. Forty-five nonanatomic (atypical) resections and 26 lobectomies were performed. Fungal infection was histologically proven in 53 patients. Reoperation was needed in four patients (bronchial stump dehiscence, persistent air leak, chylothorax, and seroma). Minor complications at the site of surgery occurred in 14 patients. In only two, there was an uncontrolled disseminated fungal infection. Overall, mortality at 30 days was 7% (five of 71). Long-term survival was mainly influenced by the underlying hematologic disease.
CONCLUSIONS
Lung resection is a therapeutic option for hematologic patients with pulmonary fungal infection. Despite immunosuppression, the perioperative morbidity and mortality is acceptable, and, therefore, the prognosis is not determined by the surgical intervention.
Pulmonary invasive fungal disease is a frequent complication in patients with hematologic malignancies. Surgical resection in addition to antifungal therapy is an option for selected cases but often feared because of immunosuppression.
METHODS
We analyzed the outcome of 71 patients undergoing lung resection for pulmonary invasive fungal disease. Most patients had leukemia, 44 underwent high-dose chemotherapy, and 18 underwent stem cell transplantation.
RESULTS
On the day of surgery, 44 patients were neutropenic, and 41 had a platelet count < 50 × 109/L. Forty-five nonanatomic (atypical) resections and 26 lobectomies were performed. Fungal infection was histologically proven in 53 patients. Reoperation was needed in four patients (bronchial stump dehiscence, persistent air leak, chylothorax, and seroma). Minor complications at the site of surgery occurred in 14 patients. In only two, there was an uncontrolled disseminated fungal infection. Overall, mortality at 30 days was 7% (five of 71). Long-term survival was mainly influenced by the underlying hematologic disease.
CONCLUSIONS
Lung resection is a therapeutic option for hematologic patients with pulmonary fungal infection. Despite immunosuppression, the perioperative morbidity and mortality is acceptable, and, therefore, the prognosis is not determined by the surgical intervention.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1378/chest.11-1964
- PMID 22459769
- Persistent URL
- https://sonar.ch/global/documents/288487
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