Format

Send to

Choose Destination
See comment in PubMed Commons below
Chest. 2004 Dec;126(6):1783-8.

Predicting outcome after lung resection for invasive pulmonary aspergillosis in patients with neutropenia.

Author information

1
Division of Cardio-Thoracic Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland. pmatt@uhbs.ch

Abstract

STUDY OBJECTIVES:

To investigate the factors that predict survival after lung resection for invasive pulmonary aspergillosis (IPA) in patients with neutropenia, in order to assist the selection of patients who are most likely to have a successful outcome.

DESIGN:

Retrospective single-center study.

SETTING:

University hospital hemato-oncologic isolation unit and division of thoracic surgery.

PATIENTS:

Forty-one patients with hematologic disease and suspected IPA who underwent lung resection.

INTERVENTIONS:

Lobectomy (n = 23), wedge resection (n = 16), and enucleation (n = 2).

RESULTS:

Mortality within 30 days was 10% (4 of 41 patients). Major perioperative complications occurred in 10%. One death was possibly related to surgery (pleural aspergillosis). Of the patients with proven aspergillosis, 87.1% were cleared of infection, but fungal relapse occurred in 10%. Overall survival was 65% at 6 months, 58% at 12 months, and 40% at 5 years after surgery. Baseline characteristics and intraoperative data did not differ significantly between survivors and nonsurvivors at 6 months or 12 months after surgery. Perioperative complications did not significantly influence the outcome. Multivariate analysis of 12-month survival revealed that the variables, progression, or recurrence of the underlying hematologic disease (relative risk [RR], 4.64; 95% confidence interval [CI], 3.51 to 5.77; p < 0.0001), fungal relapse (RR, 5.06; 95% CI, 3.83 to 6.28; p < 0.0001), and to a minor extent the type of the underlying hematologic disease (p < 0.018) were the most important predictors of patient survival.

CONCLUSIONS:

Lung resection for IPA is feasible with an acceptable operative risk. While at 10%, the perioperative mortality is considerable; the nonsurgical mortality is reported to be between 30% and 90%. Fungal infection is cleared in > 80% of patients. Mid- to long-term survival can be achieved if the underlying hematologic disease is under control. It is not yet possible to define a group of patients with IPA who are most likely to benefit from lung resection.

Comment in

PMID:
15596674
DOI:
10.1378/chest.126.6.1783
[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Support Center