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Localized invasive pulmonary aspergillosis in patients with neutropenia. Effectiveness of surgical resection
P Moreau1, J R Zahar, N Milpied
1Department of Hematology, Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France.
Background:
Invasive pulmonary aspergillosis (IPA) is a major cause of morbidity and mortality in patients with neutropenia. Two severe complications with poor outcome can be observed after apparently successful IPA medical treatment: severe hemoptysis and IPA relapse during subsequent cytotoxic treatments. Early surgical therapy has not been considered routinely in the management of localized IPA.
Methods:
Six consecutive patients (four women, two men; median age, 52 years) with localized cavitating IPA diagnosed during chemotherapy-induced aplasia were treated with early surgical resection after hematologic recovery.
Results:
All patients received a lobectomy. Surgery was uneventful. This procedures allows patients to proceed with further intensive chemotherapy and/or bone marrow transplantation without IPA reactivation.
Conclusions:
For selected patients, surgical resection of localized IPA with unique cavitating lesion, which prevents hemoptysis and IPA recurrence and allows for subsequent cytotoxic treatment, may be recommended.
Insights
Early surgery for localized invasive pulmonary aspergillosis (IPA) in neutropenic patients can prevent complications like hemoptysis and relapse. This approach allows for continued chemotherapy and bone marrow transplantation.
Area of Science:
- Pulmonology
- Oncology
- Infectious Diseases
Background:
- Invasive pulmonary aspergillosis (IPA) significantly increases morbidity and mortality in neutropenic patients.
- Post-treatment IPA complications include severe hemoptysis and relapse during chemotherapy.
- Localized IPA management has historically excluded early surgical intervention.
Purpose of the Study:
- To evaluate the efficacy of early surgical resection for localized cavitating invasive pulmonary aspergillosis in patients undergoing chemotherapy.
Main Methods:
- Six patients with localized cavitating IPA during chemotherapy-induced aplasia underwent surgical resection (lobectomy) after hematologic recovery.
- The study focused on patients with a unique cavitating lesion.
Main Results:
- All surgical procedures (lobectomies) were performed without complications.
- Surgical resection enabled patients to continue with intensive chemotherapy and/or bone marrow transplantation.
- No IPA reactivation was observed post-surgery.
Conclusions:
- Early surgical resection is a viable option for selected patients with localized cavitating IPA.
- This strategy effectively prevents hemoptysis and IPA recurrence.
- Surgical intervention facilitates subsequent cytotoxic treatments, improving patient outcomes.