Radical Surgery of Rhino-Orbito-Cerebral Mucormycosis Impacts its Prognosis

Ref ID: 18787

Author:

P. Vironneau, MD (Doctor of Medicine) – Assistant1, F. Lanternier, MD – Research Assistant 2,3, D. Garcia-Hermoso, MD – Research Assistant 3, G. Morizot, MD – Research Assistant 3, C. Elie, MD – Clinical practicer 2, F. Dromer, MD – Head research 3,

Author address:

1Hosp Lariboisiere, Paris, France, 2Hosp Necker-Enfants malades, Paris, France, 3Institut Pasteur, Paris, France.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: Rhino-orbito-cerebral mucormycosis (ROCM) is a potentially lethal, rapidly progressive invasive infection, caused by filamentous fungi belonging to Mucorales order and mostly occurring in immunocompromised hosts. Surgery is mandatory in addition to antifungal therapy but its precise modalities remain a matter of debate. Methods: We present our surgical experience of 22 consecutive ROCM adults included in the RetroZygo Cohort from May 2005 to December 2007 (Lanternier CID 2012) in whom we evaluated the relationship between local control after surgery and overall survival. Results: The overall survival rate was 57%. The 3-months and 1-year actuarial (Kaplan-Meier life table method) survival estimate were 100% and 92.3% when ROCM was controlled locally and 25 and 0% if not, respectively. Local control was obtained in 90% of cases with radical surgery and in 41.6% without radical surgery. The 3-months and 1-year actuarial survival estimates were respectively 90% and 80% for patients who underwent radical surgical treatment and 0% and 0% for those who underwent only debridement of necrotic tissues. In univariate analysis, factors related to poor survival included hematologic malignancies (p <0.05), chemosis (p <0.05), VI nerve palsy (p<0.05) and behaviour disorder (p<0.05). Conclusions: Local control of ROCM after radical surgery is associated with an improved outcome and will justify the prospective evaluation of a systematic second surgical look in combination with antifungals during ROC.

Abstract Number: M-1686

Conference Poster: y

Conference Year: 2012

Link to conference website: NULL

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