Surgical Outcomes and Exploratory Preoperative Risk Stratification for Invasive Pulmonary Fungal Infections in...

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.