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

Ann Thorac Surg. 1999 Aug;68(2):321-5. doi: 10.1016/s0003-4975(99)00513-5.


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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Female
  • Follow-Up Studies
  • Humans
  • Intraoperative Complications / etiology
  • Intraoperative Complications / mortality
  • Intraoperative Complications / surgery
  • Lung Diseases, Fungal / diagnosis
  • Lung Diseases, Fungal / mortality
  • Lung Diseases, Fungal / surgery*
  • Male
  • Middle Aged
  • Neutropenia / diagnosis
  • Neutropenia / mortality
  • Neutropenia / surgery*
  • Opportunistic Infections / diagnosis
  • Opportunistic Infections / mortality
  • Opportunistic Infections / surgery*
  • Pneumonectomy*
  • Postoperative Complications / etiology
  • Postoperative Complications / mortality
  • Postoperative Complications / surgery
  • Survival Rate