Factors affecting surgical resection and treatment outcomes in patients with pulmonary mucormycosis

Background: Surgical resection is the cornerstone treatment for pulmonary mucormycosis, a lethal fungal infection. It is unclear why some patients do not receive surgery, and the natural courses of these patients have not been well evaluated. Methods: A retrospective review was performed using the medical records of 20 patients with pathologically-confirmed pulmonary mucormycosis. We evaluated the reasons for not receiving surgery and compared treatment outcomes between patients who did and did not undergo surgery. Results: Overall survival rate was 50%. Nine of 11 (82%) patients who underwent surgery survived; however, only 1 of 9 (11%) patients who did not undergo surgery survived. Reasons for not receiving surgery were death shortly after diagnosis (n=1), altered mental state (n=1), refractory underlying disease (n=3), and refusal by patient due to concern of operative risk (n=4). Patients who did not undergo surgery were more likely to be older (P=0.018), have a longer duration of steroid use (P=0.021), higher lactate dehydrogenase level (P=0.039), higher sequential organ failure assessment (SOFA) score (P=0.035), and higher rate of cytomegalovirus (CMV) infection (P=0.020) than those did receive surgery. Surgery was the only favorable survival factor in multivariable analyses (adjusted odds ratio for survival =15.45; P=0.029). Conclusions: The main reasons for not undergoing surgery in patients with pulmonary mucormycosis were the gravity of underlying diseases and concerns for operative risk. Although overall survival rate was poor, it was significantly higher in patients who received pulmonary resection surgery. The decision to undergo lung resection is time-sensitive and essential in improving survival rate in patients suffering from pulmonary mucormycosis, despite perioperative risks.