Diagnostic and therapeutic thoracic surgery in leukemia and severe aplastic anemia

Abstract

We conclude that resection of localized pulmonary lesions, be it for diagnostic or therapeutic (or combined) purposes, can be carried out with low morbidity and mortality in patients with leukemia and severe aplastic anemia. However, early mortality is high after open or thoracoscopic lung biopsies in patients with acute-onset diffuse pulmonary disease, and little therapeutic benefit is realized in these cases.

The outcome of pulmonary resection for invasive fungal infection complicating haematological malignancy

“…Whether surgical or medical treatment for localized lesions is better is not clear, and there has been no prospective randomized study comparing medical treatment and surgical treatment in IFI in lungs. But our results have shown that therapeutic resection plays a good role in controlling local infections with an acceptable postoperative complication rate, which is consistent with previous reports [2][3][4]8]. The presence of bilateral lesions is a special consideration and controversial even if each lesion is localized and can be completely resected sequentially.…”

“…As shown in our results, diagnostic biopsy should be discussed separately from therapeutic resection because the surgical indication, surgical approach and type of operation are quite different between the two types of procedures. Habicht et al [2] and Theodore et al [3] argued that diagnostic biopsy carries a significantly higher risk than therapeutic resection, while diagnostic biopsy in our study proved to be carried out more safely in haematological patients than therapeutic resection. Owing to relatively small numbers in previous publications and a variety of patient backgrounds, there will hardly be a consensus to risk estimation in diagnostic biopsy.…”

“…Even if complete resection is achieved, postoperative antifungal agents are necessary for secondary prophylaxis [2,4], as we recommend as well.…”

“…Although cavitary lesions and halo signs in CT are highly suggestive of IFI in haematological patients with neutropenia, diffuse infiltrates are non-specific and will also include possibilities of non-infectious processes such as haemorrhage, congestive heart failure or haematological lesions [1]. Given the fact that negative bronchioalveolar lavage or sputum culture hardly rules out infection in haematological patients with radiological abnormalities [2][3][4], only surgical lung biopsy will give a good diagnostic yield. Surgical biopsy, by giving us a larger specimen than sputum or bronchioalveolar lavage, will help us identify the fungal species, which leads to appropriate choice of an antifungal agent.…”

Diagnosis and treatment of invasive pulmonary aspergillosis in neutropenic patients

“…However these patients are high-risk candidates for perioperative complications, and surgery for diagnostic reasons alone is not advisable [79]. The value of lung resection in the therapy of IPA is discussed below.…”