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

Hamaji, Masatsugu; Cassivi, Stephen D.; Shen, K. Robert; Wigle, Dennis A.; Allen, Mark S.; Nichols, Francis C.; Deschamps, Claude

doi:10.1093/ejcts/ezt518

Cited by 4 publications

(5 citation statements)

References 9 publications

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“…In our experience, OS in patients with single lesions was similar to that in patients with multiple pulmonary lesions. This result differs from that of Hamaji et al [21].…”

Section: Discussioncontrasting

confidence: 99%

Emergency and elective pulmonary surgical resection in haematological patients with invasive fungal infections: a report of 50 cases in a single centre

Chrétien

Legouge

Pagès

et al. 2016

Clinical Microbiology and Infection

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Invasive fungal infections (IFI) remain life-threatening complications in haematological patients. The aim of the study was to present the experience of a single centre in the surgical treatment of pulmonary IFI. Between 1992 and 2014, 50 haematological patients with IFI underwent pulmonary resection. In 27 cases it was an emergency procedure to avoid haemoptysis (if the lesion threatened pulmonary vessels). The remaining 23 patients underwent elective surgery before new chemotherapy or stem-cell transplantation. Among these patients (median age: 54 years; range: 5-70 years), 92% had acute leukaemia and 68% were on haematological first-line therapy (receiving induction or consolidation chemotherapies). Invasive pulmonary aspergillosis and pulmonary mucormycosis were diagnosed in 37 and 12 patients, respectively. One patient had IFI due to Trichoderma longibrachiatum. All of the patients received antifungal agents. In the month preceding IFI diagnosis, 94% of patients had been neutropenic. At the time of surgery, 30% of patients were still neutropenic and 54% required platelet transfusions. Lobectomy or segmentectomy were performed in 80% and 20% of cases, respectively. Mortality at 30 and 90 days post-surgery was 6% and 10%, respectively. After surgery, median overall survival was 21 months; median overall survival was similar between patients with emergency or elective surgery and between the types of IFI (invasive pulmonary aspergillosis or pulmonary mucormycosis). However, overall survival was far better in haematological first-line patients or in those achieving a haematological complete response than in other patients (p <0.001). In pulmonary IFI, lung resection could be an effective complement to medical treatment in selected haematological patients.

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“…In our experience, OS in patients with single lesions was similar to that in patients with multiple pulmonary lesions. This result differs from that of Hamaji et al [21].…”

Section: Discussioncontrasting

confidence: 99%

Emergency and elective pulmonary surgical resection in haematological patients with invasive fungal infections: a report of 50 cases in a single centre

Chrétien

Legouge

Pagès

et al. 2016

Clinical Microbiology and Infection

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“…We also observed a better survival in more recent studies (Fig. 3) than in those published during previous decades [23,109,110], even after adjusting for the sample size and the study design (Table 2). Second, the type of data could influence the reported mortality.…”

Section: Discussionsupporting

confidence: 63%

Has the mortality from pulmonary mucormycosis changed over time? A systematic review and meta-analysis

Muthu

Agarwal

Dhooria

et al. 2021

Clinical Microbiology and Infection

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Objectives: Pulmonary mucormycosis (PM) is increasingly being reported in immunocompromised patients and has a high mortality. Our aim was to assess the mortality of PM and its trend over time. We also evaluated the role of combined medicalesurgical therapy in PM. Methods: We performed a systematic review of Pubmed, Embase, and Cochrane central databases. Studies were eligible if they described at least five confirmed cases of PM and reported mortality. We also assessed the effect of combined medicalesurgical therapy versus medical treatment alone on PM mortality. We used a random-effects model to estimate the pooled mortality of PM and compared it across three time periods. The factors influencing mortality were assessed using meta-regression. We evaluated the risk difference (RD) of death in the following: subjects undergoing combined medicalesurgical therapy versus medical therapy alone, subjects with isolated PM versus disseminated disease, and PM in diabetes mellitus (DM) versus non-DM as a risk factor. Results: We included 79 studies (1544 subjects). The pooled mortality of PM was 57.1% (95% confidence interval [CI] 51.7e62.6%). Mortality improved significantly over time (72.1% versus 58.3% versus 49.8% for studies before 2000, 2000e2009, and 2010e2020, respectively, p 0.00001). This improved survival was confirmed in meta-regression after adjusting for the study design, the country's income level, and the sample size. Combined medicalesurgical therapy was associated with a significantly lower RD (95%CI) of death: e0.32 (e0.49 to e0.16). The disseminated disease had a higher risk of death than isolated PM, but DM was not associated with a higher risk of death than other risk factors. Conclusions: While PM is still associated with high mortality, we noted improved survival over time. Combined medicalesurgical therapy improved survival compared to medical treatment alone.

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“…It currently remains unclear whether surgical or medical treatment for localized lesions is better, and a prospective randomized study has not yet been conducted to compare the medical and surgical treatment of IFI in the lung. Our results showed that resection contributed to the control of local infections with an acceptable postoperative complication rate, which is consistent with previous findings [ 1 , 2 ].…”

Section: Discussionsupporting

confidence: 93%

“…Invasive fungal infections (IFIs) associated with hematological malignancies are common (approximately 5%) [ 1 ] and have a high mortality rate. The risk of IFIs is high due to treatments for long-term neutropenia, such as chemotherapy for acute leukemia and hematopoietic stem cell transplantation (HSCT).…”

Section: Introductionmentioning

confidence: 99%

Surgery for Pulmonary Fungal Infections Complicating Hematological Malignancies

Yamamichi

Horio

Asakawa

et al. 2018

Korean J Thorac Cardiovasc Surg

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BackgroundThe complication rate of fungal disease is higher among patients with hematological malignancies. We investigated the clinicobacteriological outcomes of resected pulmonary fungal infections complicating hematological malignancies.MethodsBetween 2001 and 2017, 21 patients with pulmonary fungal infections complicating hematological malignancies underwent resection, and their clinical records and survival were retrospectively reviewed.ResultsThe median age of the patients was 47 years, and 13 were male. The histological diagnoses were pulmonary aspergillosis (19 cases), mucormycosis (1 case), and cryptococcosis (1 case). The indications for surgery were resistance to antifungal therapy and the necessity of surgery before hematopoietic stem cell transplantation in 13 and 8 cases, respectively. The diagnoses of the hematological malignancies were acute myelogenous leukemia (10 cases), acute lymphocytic leukemia (5 cases), myelodysplastic syndrome (3 cases), and chronic myelogenous leukemia, malignant lymphoma, and extramedullary plasmacytoma (1 case each). The surgical procedures were partial resection (11 cases), segmentectomy (5 cases), lobectomy (4 cases), and cavernostomy (1 case). The size of the lesions was 0.9–8.5 cm. Fourteen cases had cavitation. There were no surgical-related deaths or fungal progression.ConclusionPulmonary fungal infections are resistant to treatments for hematological malignancies. Since the treatment of the underlying disease is extended and these infections often recur and are exacerbated, surgery should be considered when possible.

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

Cited by 4 publications

References 9 publications

Emergency and elective pulmonary surgical resection in haematological patients with invasive fungal infections: a report of 50 cases in a single centre

Emergency and elective pulmonary surgical resection in haematological patients with invasive fungal infections: a report of 50 cases in a single centre

Has the mortality from pulmonary mucormycosis changed over time? A systematic review and meta-analysis

Surgery for Pulmonary Fungal Infections Complicating Hematological Malignancies

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