Successful surgical management of invasive pulmonary fungal infection in patients with leukemia

Background: Invasive pulmonary aspergillosis (IPA) is an opportunistic fungal infection affecting patients who are undergoing chemotherapy for hematological malignancies, have hematopoietic stem cell transplants, and are immunosuppressed. Surgical treatment for IPA is remains challenging and controversial due to the potentially high risk of mortality and morbidity. Methods: We discuss 4 leukemia patients who underwent surgery for IPA in our hospital who were successfully treated with curative lobectomy or wedge resection. All patients had uneventful postoperative courses, and all resumed long-term follow-up for their leukemia. Results: All patients have suffered at least once of hemoptysis with radiological findings of lung nodules appearing as ovoid soft-tissue opacities in the lung parenchyma and had undergone antifungal agent treatment for at least 2 weeks. The symptoms and infection sites were not better. Lobectomy was performed in 3 cases and wedge resection in 1 case. Two of the cases suffered Aspergillus infection, 1 suffered Trichoderma and 1 suffered Candida albicans. Median hospital stay after surgery was 17.25 days. There was only 1 patient who had prolonged air leak (n=1; 25%) with empyema. There were no mortalities during the perioperative period or within 30 days of surgery, all patients survived without recurrence and resumed anti-leukemia treatment as soon as possible. Conclusion: Surgical resection of focal invasive pulmonary aspergillosis can be a safe and feasible treatment option in appropriately selected cases.