VATS-resection and lobectomy for invasive pulmonary aspergillosis in severely immunocompromised patients with hematologic diseases

Michael Tamm, Christian Nebiker, Franco Gambazzi, Lilian Junker, Peter Matt, James Habicht, Jörg Halter, Dominik Heim, Martin Stern, Christoph Bucher, Alois Gratwohl, Daiana Stolz, Lukas Bubendorf, Didier Lardinois.

Author address: 

1Clinic of Pulmonary Medicine and Cell Research, University Hospital of Basel, Switzerland 2Clinic of Thoracic Surgery, University Hospital of Basel, Switzerland 3Clinic of Surgery, Kantonsspital Bruderholz, Switzerland 4Clinic of Cardiac Surgery, Un

Abstract: 

Patients with hematologic diseases are often treated with aggressive immunosuppressive therapies. IPA is associated with a high mortality despite the introduction of new antifungal agents. Lung resection is a therapeutic option for selected cases with IPA. We analysed the perioperative outcome of all hematologic patients undergoing diagnostic/therapeutic lung resection for IPA over 25 years. 69 patients underwent lung resection: 48 leukaemia, 6 MDS, 8 aplastic anemia, 5 lymphoma, 1 melanoma and 1 multiple myeloma. 42 patients underwent high dose chemotherapy, 18 stem cell transplantation and 6 ATG therapy. On the day of surgery 36 patients were neutropenic. Mean platelet count was 83 x 109/L. Persistent fungal infection could histologically be documented in the resected lung tissue in 74%. Reoperation had to be performed in 4 cases: bronchial stump dehiscence, persistent airleak, chylothorax and seroma). Minor complications at the site of surgery occurred in 12 cases (6 pleural effusion; 2 hematothorax; 2 seroma 2 prolonged airleak). In only 2 cases there was uncontrolled disseminated fungal infection (pleural aspergillosis; cerebral aspergillosis). Overall 30-day-mortality was 7.2%. Medium and longterm patient survival was mainly influenced by progression or reoccurrence of the underlying hematologic disease and neither by the surgical procedure nor by unsuccessful resection of the fungus. Conclusion: Lung resection is a therapeutic option for patients with hematologic diseases suffering from IPA. Perioperative morbidity/mortality is not very high and the prognosis determined rather by the underlying hematologic disease than the surgical procedure.
2010

abstract No: 

172

Full conference title: 

20th European Respiratory Society conference
    • ERS 20th (2010)