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Updated: Jun 29, 2026
Histological Quantification to Determine Lung Fungal Burden in Experimental Aspergillosis
Published on: March 9, 2018
Surgical Outcomes and Exploratory Preoperative Risk Stratification for Invasive Pulmonary Fungal Infections in
Gang Yang1, Chang Xu1, Taozhen He1
1Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Insights
A new risk score helps predict surgical outcomes for children with invasive pulmonary fungal infections (IPFIs). This tool aids in managing surgical risk and recovery time, especially for high-risk patients undergoing lung resection.
Area of Science:
- Pediatric Pulmonology
- Surgical Oncology
- Infectious Diseases
Background:
- Invasive pulmonary fungal infections (IPFIs) pose significant risks for immunocompromised children, potentially disrupting critical treatments like chemotherapy and hematopoietic stem cell transplantation (HSCT).
- Limited evidence exists for stratifying perioperative risk in pediatric patients undergoing surgical management for IPFIs.
Purpose of the Study:
- To evaluate surgical outcomes in children with IPFIs.
- To develop and validate a preoperative risk score for predicting surgical complications and recovery time in pediatric patients with IPFIs.
Main Methods:
- A retrospective cohort study included 33 children (<16 years) with proven/probable IPFI who underwent lung resection.
- Data collected included preoperative clinical variables, laboratory results, and CT features.
- An exploratory weighted risk score was developed and evaluated based on independent predictors of outcomes.
Main Results:
- Aspergillus was the most common pathogen; most lesions were central and required lobectomy or wedge resection.
- Key predictors for severe complications included low preoperative platelet count, multilobe involvement, and central lesion location.
- The developed risk score effectively stratified patients into low, moderate, and high-risk groups for severe complications and delayed resumption of chemotherapy/HSCT.
Conclusions:
- Surgical intervention can facilitate source control and enable timely oncologic treatment in select pediatric IPFI cases.
- A validated preoperative risk score can assist in anticipating surgical risks, recovery timelines, and identifying high-risk individuals.
- The score aids in optimizing management strategies for pediatric patients with IPFIs undergoing surgery.
Background:
Invasive pulmonary fungal infections (IPFIs) in immunocompromised children carry high morbidity and may interrupt life-saving chemotherapy or haematopoietic stem cell transplantation (HSCT). Evidence on perioperative risk stratification for surgical management is limited.
Patients And Methods:
We conducted a single-center retrospective cohort study of patients < 16 years with proven/probable IPFI who underwent lung resection from 2017 to 2025, with fungal infection confirmed by pathology. Preoperative clinical variables, laboratory tests and CT features were collected. Outcomes included intraoperative blood transfusion, severe postoperative complications, 90-day mortality and time to resumption of chemotherapy/HSCT. An exploratory preoperative weighted risk score was derived and evaluated.
Results:
Thirty-three patients were included (median age 9 years; 75.8% male). Aspergillus was the most common pathogen (72.7%); 57.6% had centrally located lesions and 12.1% had multilobe involvement. Procedures were mainly lobectomy (66.7%) or wedge resection (30.3%), with VATS in 45.5%. Peripheral lesion location was associated with less intraoperative transfusion, while hemoptysis and central lesion predicted delayed resumption of chemotherapy/HSCT; preoperative platelet count < 100 × 109/L, multilobe involvement and central location were significantly associated with severe complications. Integrating these independent findings, a 0-8 point composite risk score was constructed (optimism-adjusted C-index: 0.948). The model effectively stratified outcomes: severe complications occurred in 0% (low), 26.7% (moderate) and 75% (high) (p = 0.004). Among survivors, median time to resume chemotherapy/HSCT was 18 days (low) versus 35 days (moderate) versus 78 days (high) (p < 0.001). All 90-day deaths occurred in the high-risk group (p < 0.001).
Conclusions:
Surgery can support source control and timely oncologic treatment in selected paediatric IPFI. A simple, statistically validated preoperative score may help anticipate surgical risk and recovery time and identify a high-risk subgroup with poor short-term outcomes.
