title: Full thoracoscopic approach for surgical management of invasive pulmonary aspergillosis.
abstract: 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.
authors.affiliation: Thoracic Department, Institut Mutualiste Montsouris, Paris, France. dominique.gossot@imm.fr
authors.forename: Dominique
authors.initials: D
authors.lastname: Gossot
authors.forename: Pierre
authors.initials: P
authors.lastname: Validire
authors.forename: Rosaire
authors.initials: R
authors.lastname: Vaillancourt
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
authors.forename: Hélène
authors.initials: H
authors.lastname: Esperou
authors.forename: Agnes
authors.initials: A
authors.lastname: Devergie
authors.forename: Philippe
authors.initials: P
authors.lastname: Guardiola
authors.forename: Dominique
authors.initials: D
authors.lastname: Grunenwald
authors.forename: Eliane
authors.initials: E
authors.lastname: Gluckman
authors.forename: Patricia
authors.initials: P
authors.lastname: Ribaud
mesh_terms: 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