The outcome of pulmonary resection for invasive fungal infection complicating haematological malignancy.
OBJECTIVE
The aim of this study was to clarify clinical outcomes of pulmonary resection of invasive fungal infection (IFI) complicating haematological malignancy.


METHODS
Between 1985 and 2010, 28 patients underwent 31 pulmonary procedures for IFI complicating haematological malignancy. Retrospective chart review was performed. Seventeen patients underwent therapeutic resection and 11 patients underwent diagnostic biopsy. Survival and progression of fungal infection were analysed with the Kaplan-Meier method and prognostic factors were analysed with the Cox proportional hazards model.


RESULTS
The median follow-up was 9.5 months (range 0-139 months). The rate of operative complications is significantly higher in the therapeutic resection group (P=0.036) in multivariate analysis. Median survival was 12 and 5 months in the diagnostic and therapeutic group, respectively. In the diagnostic group, 10 patients (91%) survived surgery and were cured of fungal infection; the management was changed based on biopsy in 3 patients (27.3%), and preoperative anaemia (P=0.044) adversely affected survival in multivariate analysis. In the therapeutic group, anaemia (P=0.018) and perioperative transfusion (P=0.038) adversely affected survival following therapeutic resection in univariate analysis. The rate of fungal progression in the therapeutic group was 29.4%. In multivariate analysis, only presence of bilateral lesions (P=0.0005) was a significant factor of fungal progression after therapeutic resection.


CONCLUSIONS
Diagnostic biopsy contributes to good diagnostic yield with long-term cure from fungal infection. The long-term outcome (overall survival) of diagnostic and therapeutic patients relied on the severity of anaemia, which appears related to underlying haematological diseases. Presence of bilateral lesions was a significant factor of fungal progression after therapeutic resection.
Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN, USA.
Masatsugu
M
Hamaji
Stephen D
SD
Cassivi
K Robert
KR
Shen
Dennis A
DA
Wigle
Mark S
MS
Allen
Francis C
FC
Nichols
Claude
C
Deschamps
D000293:Adolescent; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D019337:Hematologic Neoplasms / Q000382:microbiology* / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008172:Lung Diseases, Fungal / Q000382:microbiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
Fungi; Haematology; Infection; Lung