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


METHODS
Retrospective single-center study.


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


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


METHODS
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.
Matt
Peter
P
Division of Cardio-Thoracic Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland. pmatt@uhbs.ch
Bernet
Franziska
F
Habicht
James
J
Gambazzi
Franco
F
Gratwohl
Alois
A
Zerkowski
Hans-Reinhard
HR
Tamm
Michael
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000150:complications / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008172:Lung Diseases, Fungal / Q000150:complications / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications*; D009894:Opportunistic Infections / Q000150:complications / Q000401:mortality / Q000601:surgery*; D011013:Pneumonectomy / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome