Full thoracoscopic approach for surgical management of invasive pulmonary aspergillosis.
BACKGROUND
Invasive pulmonary aspergillosis (IPA) is a frequent and serious infection occurring in patients with hematologic malignancies and allogenic stem cell transplant (SCT) recipients, causing a high mortality rate. We report the use of full thoracoscopic management in 19 patients.


METHODS
Nineteen patients (mean age 27 years) with diagnosed or probable IPA were operated on. Seventeen had an hematologic malignancy and 2 had a refractory aplastic anemia. Nine patients had undergone an allogenic SCT that was complicated by a graft-versus-host disease in 5 patients. In 3 patients, SCT was pending. All patients had preoperative systemic antifungal therapy for at least 2 weeks. Fifteen patients had only one lesion, whereas 4 had two lesions. Eight patients had an absolute neutrophil count less than 3,000 and 2 less than 1,000, and 9 were thrombopenic (platelet count <60,000) at the day of surgery. Wedge resections were performed in 7 patients and lobectomies were performed for the other 12. For the latter, an open approach via posterolateral thoracotomy was decided upon in only 1 patient. For the other 11 lobectomies, a mini-thoracotomy was needed in 3 cases for intraoperative difficulties. Conversion to conventional thoracotomy was necessary for 2 of these patients. In total, out of the 19 patients, 15 had a total endoscopic approach, 3 had a thoracotomy, and 1 had a video-assisted approach.


RESULTS
There was no intraoperative mortality. In the group of wedge resections, no intraoperative or postoperative complication occurred. In the lobectomy group, three hemorrhages occurred during dissection of the pulmonary artery in the fissure, leading to conversion to a mini-thoracotomy in 2 patients and to a classic posterolateral thoracotomy in 1 patient. There were two minor complications: one pneumothorax and one mild pleural effusion.


CONCLUSIONS
In these debilitated and immunocompromised patients, a full thoracoscopic resection of fungal infection is feasible, even for lobectomies. It allows a simpler postoperative course and minimizes sequelae.
Gossot
Dominique
D
Thoracic Department, Institut Mutualiste Montsouris, Paris, France. dominique.gossot@imm.fr
Validire
Pierre
P
Vaillancourt
Rosaire
R
Socié
Gérard
G
Esperou
Hélène
H
Devergie
Agnes
A
Guardiola
Philippe
P
Grunenwald
Dominique
D
Gluckman
Eliane
E
Ribaud
Patricia
P
D000293:Adolescent; D000328:Adult; D001228:Aspergillosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000601:surgery*; D008297:Male; D011013:Pneumonectomy / Q000379:methods*; D013906:Thoracoscopy; D013908:Thoracotomy; D016896:Treatment Outcome