Background and Aims: Invasive fungal disease (IFD) affects primarily
patients with a compromised immune system, mainly children with a
hematological malignancy. This type of infection is often aggressive and
related with high mortality, despite the improvement of medical treatment.
New evidences report that the association of medical treatment
and surgery may ameliorate the outcome. The aim of this study was to
analyze the surgical experience of a single-center in the treatment of
fungal infections in the pediatric oncological populations.
Methods: Retrospective study (2000 to 2020) of a single-center experience.
We reviewed the medical record of all patients with hematologic
malignancies. We analyzed presentation and diagnosis of IFD,
medical treatment, indication for surgery, type of surgical treatment
and outcomes including complications (rated according to Clavien
Dindo Classification), eventual delay in the resume of the oncological
treatment, resolution of infection, relapse and survival.
Results: Forty patients (19M, 21F), median age 8 years (0-17) at the
diagnosis of IFD. The main indications for surgery were no benefits
from medical treatment and advance of fungal infection (67%), the
need to confirm the diagnosis (12,5%), and only two patients needed
an emergency operation for rapid worsening of symptoms. The most
common site of infection was the lung (80%), followed by maxillofacial
region (17.5%) and the most frequently identified pathogen was
Aspergillus (25%). The most common procedures were lobectomy
(performed in 16 patients) and lung resection (8). Complications
were mostly treated by medical approach. Only in 7 cases mycoses
were persistent after surgery. The median time of resumption oncological
treatment was 40 days (range 0-150). Reason of death was
predominantly related to refractorymalignancy (18).
Conclusions: Surgery is a feasible tool in the multimodal treatment of
invasive fungal infection in pediatric oncological patients, with excellent
resolution rate. Overall mortality depends on the underlying
malignancy
