title: Lung resection in hematologic patients with pulmonary invasive fungal disease.
abstract: BACKGROUND
  Pulmonary invasive fungal disease is a frequent complication in patients with hematologic malignancies. Surgical resection in addition to antifungal therapy is an option for selected cases but often feared because of immunosuppression.
  
  
  METHODS
  We analyzed the outcome of 71 patients undergoing lung resection for pulmonary invasive fungal disease. Most patients had leukemia, 44 underwent high-dose chemotherapy, and 18 underwent stem cell transplantation.
  
  
  RESULTS
  On the day of surgery, 44 patients were neutropenic, and 41 had a platelet count < 50 × 109/L. Forty-five nonanatomic (atypical) resections and 26 lobectomies were performed. Fungal infection was histologically proven in 53 patients. Reoperation was needed in four patients (bronchial stump dehiscence, persistent air leak, chylothorax, and seroma). Minor complications at the site of surgery occurred in 14 patients. In only two, there was an uncontrolled disseminated fungal infection. Overall, mortality at 30 days was 7% (five of 71). Long-term survival was mainly influenced by the underlying hematologic disease.
  
  
  CONCLUSIONS
  Lung resection is a therapeutic option for hematologic patients with pulmonary fungal infection. Despite immunosuppression, the perioperative morbidity and mortality is acceptable, and, therefore, the prognosis is not determined by the surgical intervention.
authors.affiliation: Division of Thoracic Surgery, University Hospital Basel, Basel, Switzerland. Electronic address: nebikerc@uhbs.ch.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Nebiker
authors.affiliation: Division of Thoracic Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Didier
authors.initials: D
authors.lastname: Lardinois
authors.affiliation: Division of Pneumology, University Hospital Basel, Basel, Switzerland.
authors.forename: Lilian
authors.initials: L
authors.lastname: Junker
authors.affiliation: Division of Thoracic Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Franco
authors.initials: F
authors.lastname: Gambazzi
authors.affiliation: Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Matt
authors.affiliation: Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: James M
authors.initials: JM
authors.lastname: Habicht
authors.affiliation: Division of Hematology, University Hospital Basel, Basel, Switzerland.
authors.forename: Joerg
authors.initials: J
authors.lastname: Halter
authors.affiliation: Division of Hematology, University Hospital Basel, Basel, Switzerland.
authors.forename: Dominik
authors.initials: D
authors.lastname: Heim
authors.affiliation: Division of Hematology, University Hospital Basel, Basel, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Stern
authors.affiliation: Division of Hematology, University Hospital Basel, Basel, Switzerland.
authors.forename: Andreas S
authors.initials: AS
authors.lastname: Buser
authors.affiliation: Division of Hematology, University Hospital Basel, Basel, Switzerland.
authors.forename: Jakob
authors.initials: J
authors.lastname: Passweg
authors.affiliation: Division of Pneumology, University Hospital Basel, Basel, Switzerland.
authors.forename: Daiana
authors.initials: D
authors.lastname: Stolz
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Ursula M
authors.initials: UM
authors.lastname: Flückiger
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Maja
authors.initials: M
authors.lastname: Weisser
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Manuel
authors.initials: M
authors.lastname: Battegay
authors.affiliation: Department of Pathology, University Hospital Basel, Basel, Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Bubendorf
authors.affiliation: Division of Hematology, University Hospital Basel, Basel, Switzerland.
authors.forename: Alois
authors.initials: A
authors.lastname: Gratwohl
authors.affiliation: Division of Pneumology, University Hospital Basel, Basel, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Tamm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy; D006801:Humans; D016867:Immunocompromised Host; D008168:Lung / Q000601:surgery*; D008172:Lung Diseases, Fungal / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000935:Antifungal Agents