Surgical aspects of resection for suspected invasive pulmonary fungal infection in neutropenic patients

Background. Morbidity and mortality of early resection of invasive pulmonar y fungal disease in neutropenic patients are still considered prohibitive f or surgical treatment. Methods. We retrospectively analyzed results of 28 (16 men, 12 women; mean age, 38.9 years) consecutive neutropenic hematologic patients who had lung resections for suspicion of invasive pulmonary fungal disease. Results. We did 28 lung resections (19 lobectomies, one bilobectomy, eight single or multiple wedge resections including three video-assisted wedge re sections). The disease was proved histologically in 22 (78.6%) cases. Intra operative difficulties, such as diffuse oozing or mycotic infiltration, and solid postinflammatory adhesions were encountered in 5 (17.8%) and 6 (21.4 %) patients respectively. In one case (3.6%) it lead to a major intra-opera tive hemorrhage. There were no intraoperative deaths, overall 30-day mortal ity rate was two of 28 (7.1%), overall 90-day mortality rate was seven of 2 8 (25%), with one death (3.6%) possibly related to surgery. Minor surgery-r elated complications were seen in ten (35.7%) cases, major surgery-related complications occurred in three (10.7%) cases. Twelve of 22 patients (54.5% ) with proven invasive fungal infection are currently alive (mean follow-up , 32.3 months). Conclusions. Surgery-related complications and mortality are acceptable for this high risk group of patients. Resection should be carried out early fo r diagnostic as well as therapeutic reasons. (C) 1999 by The Society of Tho racic Surgeons.