Outcome of Surgical Resection for Invasive Pulmonary Fungal Diseases in Patients with Acute Leukemia

Si-Hyun Kim; Su-Mi Choi; Dong-Gun Lee; Jae Kil Park; Jae-Cheol Kwon; Sun Hee Park; Hee-Je Kim; Seok Lee; Ki-Seong Eom; Jung-Hyun Choi; Jin-Hong Yoo; Woo-Sung Min

doi:10.3947/ic.2010.42.6.383

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Kim, Choi, Lee, Park, Kwon, Park, Kim, Lee, Eom, Choi, Yoo, and Min: Outcome of Surgical Resection for Invasive Pulmonary Fungal Diseases in Patients with Acute Leukemia

Original Article

Infection & Chemotherapy

Infection & Chemotherapy 2010; 42(6): 383-390.

Published online: 31 December 2010

DOI: https://doi.org/10.3947/ic.2010.42.6.383

Outcome of Surgical Resection for Invasive Pulmonary Fungal Diseases in Patients with Acute Leukemia

Si-Hyun Kim¹, Su-Mi Choi¹, Dong-Gun Lee¹

, Jae Kil Park², Jae-Cheol Kwon¹, Sun Hee Park¹, Hee-Je Kim¹, Seok Lee¹, Ki-Seong Eom¹, Jung-Hyun Choi¹, Jin-Hong Yoo¹, Woo-Sung Min¹

¹Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea.

²Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea.

Correspondence to Su-Mi Choi, M.D., PhD. Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, #62 Yeouido-dong, Yeongdeungpo-gu, Seoul 150-173, Korea. Tel: +82-2-3779-1376, Fax: +82-2-780-3132, sumichoi@catholic.ac.kr

Received 17 June 2010 Revised 13 October 2010 Accepted 14 October 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

In patients with hematologic diseases, surgical resection can be recommended for definite diagnosis, curative treatment, and prevention of complications or redevelopment of invasive pulmonary fungal diseases (IPFD). The purpose of this study was to investigate the outcome of surgical resection for IPFD in patients planned to undergo subsequent chemotherapy (CTx) or hematopoietic stem cell transplantation (HSCT) for acute leukemia.

Materials and Methods

We reviewed the medical records of adult patients with acute leukemia who underwent surgical resection for IPFD which developed during the neutropenic period after CTx.

Results

From January 2004 through August 2008, a total of 15 patients (8 males and 7 females with median age of 49 years) underwent surgical resection. All patients were treated by elective surgical resection of residual IPFD lesion before subsequent CTx or HSCT. The median diameter of the main lesion was 66 mm (range, 33-98 mm). Pericardial adhesion due to local invasion of pulmonary lesion was observed in one patient. Lobectomy was performed in 13 cases, lobectomy with wedge resection in 1 case, and segmentectomy with wedge resection in 1 case. Air leakage was complicated in 2 patients. Thirty-day mortality after surgical resection was 0%. After subsequent CTx or HSCT, IPFD redeveloped in 5 patients. However, the overall mortality was not different between the groups with or without the redevelopment of IPFD. Also, mortality attributable to IPFD was only 6% (1/15) during the overall follow-up period (median 184 days, range 58-1,251 days).

Conclusions

In patients planned to receive subsequent CTx or HSCT for acute leukemia, surgical resection combined with medical therapy for IPFD could be considered for those who have significant residual lesion. Further study will be needed to determine whether surgical resection can shorten the duration of medical treatment and improve survival outcome.

Keywords: Invasive pulmonary fungal diseases, Thoracic surgery, Acute leukemia, Chemotherapy, Hematopoietic stem cell transplantation

Figures and Tables

Figure 1

Tentative strategy of considering surgical management for invasive pulmonary fungal diseases (IPFD) in patients who have hematologic diseases and are planned to receive subsequent chemotherapy (CTx) or hematopoietic stem cell transplantation (HSCT) at catholic HSCT center.

Table 1

Demographic Characteristics of the Patients Who Underwent Surgical Resection for Invasive Pulmonary Fungal Diseases

AML, acute myeloid leukemia; ALL, acute lymphocytic leukemia; CTx, chemotherapy; IPFD, invasive pulmonary fungal diseases.

Table 2

Clinical Characteristics of Patients Who Underwent Surgical Resection for Invasive Pulmonary Fungal Diseases

Dx, diagnosis; CTx, chemotherapy; Exam., examination; IPFD, invasive pulmonary fungal diseases; GM, galactomannan; AML, acute myeloid leukemia; ALL, acute lymphocytic leukemia; N, no; Y, yes.

^aRadiologic findings were based on chest CT scan.

^bDiameter was measured at the largest main lesion.

Table 3

Subsequent Myelosuppressive Treatment for Acute Leukemia and Long Term Outcome

op, operation; Tx, treatment; IPFD, invasive pulmonary fungal diseases; Redevelop., redevelopment; CTx, chemotherapy; CR, complete response; ICZ, itraconazole; Y, yes; HSCT, hematopoietic stem cell transplantation; N, no; VCZ, voriconazole; CDAD, Clostridium difficile-associated disease; DAH, diffuse alveolar hemorrhage; PR, partial response; FCZ, fluconazole; ND, not done.

^aAt the time of subsequent CTx or HSCT.

^bDuration of follow-up was defined as the number of days from operation to last contact.

Table 4

Comparison between Patients according to the Redevelopment of Invasive Pulmonary Fungal Disease During Subsequent Myelosuppressive Treatment

IPFD, invasive pulmonary fungal diseases; Y, yes; N, no; NS, not significant; AML, acute myeloid leukemia; ALL, acute lymphocytic leukemia; CTx, chemotherapy; op., operation; postop., postoperative; Tx, treatment; CR, complete response; PR, partial response.

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ORCID iDs: Dong-Gun Lee
https://orcid.org/http://orcid.org/0000-0003-4655-0641
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