Despite new antifungal agents mortality of invasive pulmonary aspergillosis (IPA) in neutropenic patients remains high. Only few centres perform lung resection for IPA in this patient group. Most centres fear intra- and perioperative complications especially infections because of neutropenia and bleeding because of thrombopenia. We assessed the complication rate and possible prediction of outcome of lung resection for suspected IPA in a large number of hematologic patients.
Retrospective single centre study; assessment: clinical short and longterm outcome, intra- and perioperative complications, histologcal outcome and multivariant survival analysis.
41 patients with antibiotic resistant fever and nodular infiltrates on CT-scan underwent lung resection (23 lobectomy, 16 wedge resection, 2 enucleation). All patient suffered from neutropenia 71 % were still neutropenic at the day of surgery. Mean platelet count was 43 x 109/l, mean duration of the operation 110 min and mean blood loss 293 mls. Immediate extubation was possible in 40 out of 41 patients. Major complications occurred in 10 % (4/41)of patients (air leak/pleural aspergillosis; bronchial dehiscence; ARDS; liver bleeding after preoperative CT guided puncture). IPA was histologically confirmed in 76 % of cases. Overall 30 day mortality was 10 % (2 bacterial sepsis; 2 disseminated aspergillosis in persistent neutropenia). The infection was definitively cleared in 87 % of patients with histologically proven IPA. Overall survival was 65 %, 58 %, 47 % and 40 % at 6, 12, 36 and 60 months respectively. Intraoperative and perioperative factors did not affect 6 and 12 months survival. Risk factors for survival were fungal relapse and mainly progression or relapse of the underlying haematological disease.
Lung resection for IPA is effective with an acceptable morbidity and mortality. Survival is not dependent on perioperative factors, but determined by the underlying haematological disease.
Lung resection combined with antifungal therapy should be considered as a treatment option for neutropenic patients with suspected IPA.
M. Tamm, None.