AGGRESSIVE SURGICAL-MANAGEMENT IN LOCALIZED PULMONARY MYCOTIC AND NONMYCOTIC INFECTIONS FOR NEUTROPENIC PATIENTS WITH ACUTE-LEUKEMIA - REPORT OF 18 CASES

Objective: To prevent hemoptysis and relapse during subsequent chemoth erapy-induced neutropenia in patients with localized forms of invasive pulmonary aspergillosis, rye adopted an aggressive surgical approach, Methods: From 1988 to 1996, 18 patients with hematologic diseases wer e referred with the diagnosis of localized invasive pulmonary aspergil losis, The diagnosis was based on clinical features, failure to respon d to antibiotic therapy, an air crescent sign suggestive of aspergillo sis on the computed tomographic scan (39%), and retrieval of fungi by bronchoalveolar lavage (44%), Results: The following procedures were d one: one pneumonectomy, four bilobectomies, seven lobectomies, six wed ge resections, and one lobectomy with wedge resection (one patient had two procedures), No perioperative deaths or complications occurred, T he histologic examination confirmed the diagnosis of invasive pulmonar y aspergillosis in 12 patients, The six other diagnoses were as follow s: one case of classic aspergilloma, one case of pneumonia, and four c ases of pulmonary abscess, According to univariate analysis, thoracic pain was less common in the group with noninvasive pulmonary aspergill osis (1/6) than in the group with invasive pulmonary aspergillosis (8/ 12) (p < 0.05), Sixteen patients required subsequent hematologic treat ments, Sixty-six percent of the patients are alive with a mean follow- up of 29.1 +/- 27.8 months (range 2 to 103 months), with no statistica lly significant difference between the invasive and the noninvasive pu lmonary aspergillosis groups, Five patients died of a recurrence of th eir malignant disease at a mean of 17.2 +/- 12.5 months (range 2 to 30 months), and one had a cerebral recurrence of Aspergillus infection d uring a bone marrow transplantation 3 months later, Conclusion: Aggres sive surgical management radically improves the prognosis of invasive pulmonary aspergillosis, even if the surgical indications include some nonmycotic infections because of the difficulty in establishing the c linical diagnosis.