Ohtsuka Reo, Fujimori Sakashi, Suzuki Souichiro, Karasaki Takahiro, Kikunaga Shinichiro, Ito Kazuki, Hamada Yosuke, Mihara Shusei, Watanabe Otoya, Yamamoto Hisashi
Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
Department of Hematology, Toranomon Hospital, Tokyo, Japan.
Gen Thorac Cardiovasc Surg. 2025 Jun;73(6):436-442. doi: 10.1007/s11748-024-02092-0. Epub 2024 Oct 23.
Patients with hematopoietic malignancies (HM) are often immunocompromised and, therefore, susceptible to developing invasive fungal infections, including pulmonary mycosis. Surgical resection is indicated for localized pulmonary mycosis refractory to antifungal agents. This study investigated the feasibility and outcomes of minimally invasive surgery for pulmonary mycosis patients complicated with HM.
We retrospectively reviewed 56 cases of surgically treated pulmonary mycosis among the 3994 lung resections performed in our department between 2011 and 2020, focusing on the 19 cases under treatment for HM.
All patients underwent 3-port video-assisted thoracoscopic surgery, including one patient converted to open surgery. The 30 day mortality rate was zero. The overall survival rate 1 year after surgery was 63.2%. No relapse of mycosis was observed, and the majority of the cause of death was the progression of HM. The rate of major postoperative complications was comparable between the patients with HM (3/19) and without HM (5/37), despite the patients with HM having a higher frequency of immunocompromised status than those without HM. Most patients who underwent surgery before hematopoietic stem cell transplantation (HSCT) had leukocytopenia, while all patients who underwent surgery after HSCT received immunosuppressants. Mucormycosis was observed in 13 out of 19 patients (68%) with HM, and it was significantly associated with preoperative pancytopenia and usage of immunosuppressants.
Minimally invasive surgery was feasible for pulmonary mycosis complicated with HM despite the high frequency of immunosuppression. These findings will deepen our understanding of pulmonary mycosis associated with HM and may improve perioperative patient care.
造血系统恶性肿瘤（HM）患者常存在免疫功能低下，因此易发生侵袭性真菌感染，包括肺部真菌病。对于抗真菌药物治疗无效的局限性肺部真菌病，需进行手术切除。本研究探讨了微创手术治疗合并HM的肺部真菌病患者的可行性及疗效。
我们回顾性分析了2011年至2020年期间在我科进行的3994例肺切除手术中56例接受手术治疗的肺部真菌病患者，重点关注其中19例正在接受HM治疗的患者。
所有患者均接受了三孔电视辅助胸腔镜手术，其中1例转为开放手术。30天死亡率为零。术后1年总生存率为63.2%。未观察到真菌病复发，大多数死亡原因是HM进展。HM患者（3/19）和非HM患者（5/37）术后主要并发症发生率相当，尽管HM患者免疫功能低下的频率高于非HM患者。大多数在造血干细胞移植（HSCT）前接受手术的患者存在白细胞减少，而所有在HSCT后接受手术的患者均接受了免疫抑制剂治疗。19例HM患者中有13例（68%）观察到毛霉病，且与术前全血细胞减少和免疫抑制剂的使用显著相关。
尽管免疫抑制发生率高，但微创手术对于合并HM的肺部真菌病是可行的。这些发现将加深我们对与HM相关的肺部真菌病的理解，并可能改善围手术期患者护理。
