THE VALUE OF SURGERY IN THE TREATMENT OF INVASIVE PULMONARY ASPERGILLOSIS IN NEUTROPENIC PATIENTS

The aim of the study is to specify the indication for surgery in the t reatment of invasive pulmonary aspergillosis (APII. From January 1991 to October 1996 nineteen patients who had been treated with chemothera py and associated marrow aplasia and suffering from API were operated on. At the lime of the surgical intervention all of the patients were treated with antifungal drugs. The delay between the start of their sy mptoms and the start of treatment was 2.6 days (range: 0-17 days). 1. The risk of a massive haemoptysis by contact between the fungal infect ion and the pulmonary artery led to eight urgent surgical operations: six lobectomies and two lobectomies associated with segmentectomy. The mean level of polymorphonuclear neutrophils was 296 cell/mm(3) (0-1,0 00). Plastic surgery on the pulmonary artery was carried out in three patients. One patient died after the operation with progression of the API. The duration of postoperative stay was 13 days (6-18). 2. Planne d surgery consisted of a resection of the residual mass after antifung al treatment and a diagnostic approach to the intraparenchymatous mass of indeterminate aetiology. A resection of the residual masses (in sp ite of antifungal treatment) was carried out in seven patients: before further haematological therapy in six cases and iii one case for a su perinfected lesion. The type of resection was. a lobectomy (n = 4), a lingulectomy (n = 1) and an atypical resection (n = 2). No postoperati ve deaths were reported. The patients left the surgical service betwee n the seventh and twentieth clay postoperatively. The surgery was used in Sour patients as the diagnostic approach in view of intraparenchym al masses of unknown aetiology and had enabled a fungal mycelium to be isolated at the centre of persisting inflammation. Antifungal treatme nt sometimes associated with surgery allowed for a better prognosis in patients suffering from invasive pulmonary aspergillosis.