SURGICAL-MANAGEMENT OF INVASIVE PULMONARY ASPERGILLOSIS IN NEUTROPENIC PATIENTS

Background. The aim of our study was to clarify the indications for op eration in invasive pulmonary aspergillosis. Methods. Nineteen patient s with hematologic malignancy, in whom invasive pulmonary aspergillosi s developed during the course of neutropenia, had operations. Neutrope nia lasted 28 days (range, 15 to 45 days). The preoperative diagnosis of invasive pulmonary aspergillosis was based on computed tomographic scan findings (halo or air crescent signs). Results. Eight patients un derwent emergency operations, before marrow recovery, for prevention o f massive hemoptysis. The criterion for operation was an aspergillosis lesion that contacted the pulmonary artery on computed tomography. A lobectomy was performed in all cases. A sleeve resection of the pulmon ary artery was necessary on two occasions. There was one postoperative death due to extensive aspergillosis. The length of hospitalization a fter operation was 13 days (range, 6 to 18 days). Seven patients were treated by elective resection of a residual mass (before hematologic t herapy in 6 Cases). The types of resection performed were lobectomy (n = 4), lingulectomy (n = 1), and wedge resection (n = 2). There were n o postoperative deaths. The average length of stay before discharge fr om the hospital was 11 days (range, 7 to 20 days). The surgical resect ion was performed as a diagnostic procedure in the 4 remaining patient s after an allotted time of 14 days (range, 4 to 24 days) from initiat ion of antifungal therapy. Conclusions. The combination of antifungal agents and surgical resection is an efficient strategy for the treatme nt of invasive pulmonary aspergillosis iii patients with hematologic m alignancy.