The outcome of pulmonary resection for invasive fungal infection complicating haematological malignancy.

Objectives: The aim of this study was to clarify clinical outcomes of pulmonary resection of invasive fungal infection (IFI) complicating haematological malignancy.

Methods: Between 1985 and 2010, 28 patients underwent 31 pulmonary procedures for IFI complicating haematological malignancy. Retrospective chart review was performed. Seventeen patients underwent therapeutic resection and 11 patients underwent diagnostic biopsy. Survival and progression of fungal infection were analysed with the Kaplan-Meier method and prognostic factors were analysed with the Cox proportional hazards model.

Results: The median follow-up was 9.5 months (range 0-139 months). The rate of operative complications is significantly higher in the therapeutic resection group (P=0.036) in multivariate analysis. Median survival was 12 and 5 months in the diagnostic and therapeutic group, respectively. In the diagnostic group, 10 patients (91%) survived surgery and were cured of fungal infection; the management was changed based on biopsy in 3 patients (27.3%), and preoperative anaemia (P=0.044) adversely affected survival in multivariate analysis. In the therapeutic group, anaemia (P=0.018) and perioperative transfusion (P=0.038) adversely affected survival following therapeutic resection in univariate analysis. The rate of fungal progression in the therapeutic group was 29.4%. In multivariate analysis, only presence of bilateral lesions (P=0.0005) was a significant factor of fungal progression after therapeutic resection.

Conclusions: Diagnostic biopsy contributes to good diagnostic yield with long-term cure from fungal infection. The long-term outcome (overall survival) of diagnostic and therapeutic patients relied on the severity of anaemia, which appears related to underlying haematological diseases. Presence of bilateral lesions was a significant factor of fungal progression after therapeutic resection.