PMID- 32386208
OWN - NLM
STAT- MEDLINE
DCOM- 20210621
LR  - 20210621
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 58
IP  - 5
DP  - 2020 Nov 1
TI  - Clinical outcomes of patients with chronic pulmonary aspergillosis managed 
      surgically.
PG  - 997-1003
LID - 10.1093/ejcts/ezaa137 [doi]
AB  - OBJECTIVES: Surgical resection is one treatment modality for chronic pulmonary 
      aspergillosis (CPA), and sometimes a preoperative presumption of lung cancer 
      turns out to be CPA. We have audited our surgical experience with regard to risk 
      factors for relapse, and the value of postoperative monitoring of 
      Aspergillus-immunogolubulin G (IgG) titres. METHODS: All patients with CPA 
      surgically treated at National Aspergillosis Centre (NAC), Manchester, UK 
      (2007-2018), were retrospectively evaluated. Surgical procedures, underlying 
      disorders, Aspergillus-IgG titres (ImmunoCap) and antifungal therapy were 
      evaluated for symptom control, operative complications, CPA relapse and 
      mortality. RESULTS: A total of 61 patients with CPA (28 males, 33 females) were 
      operated on primarily for antifungal therapy failure (51%, n = 31) and presumed 
      lung malignancies (38%, n = 23). Procedures included lobectomy (64%, n = 39), 
      wedge resection (28%, n = 17), segmentectomy (n = 3), pneumonectomy (n = 3) and 
      decortication (n = 2). Overall, 25 (41%) patients relapsed, 26 months (standard 
      deviation: 24.8 months) after surgery. Antifungal therapy before surgery 
      (P = 0.002) or both before and after surgery (P = 0.005) were protective for 
      relapse. The relapse rate within 3 years after surgery (33%, n = 20) was higher 
      than the 3-10 years after surgery (8%, n = 5). At the end of follow-up, the 
      median Aspergillus-IgG titre was lower than at relapse in 12 patients (67 vs 
      126 mg/l) (P = 0.016). CONCLUSIONS: Surgery in these selected patients with CPA 
      resulted in favourable outcomes. Relapse is common after surgical treatment of 
      CPA but can be minimized with antifungal therapy, emphasizing the importance of 
      an accurate diagnosis prior to surgery.
CI  - (c) The Author(s) 2020. Published by Oxford University Press on behalf of the 
      European Association for Cardio-Thoracic Surgery. All rights reserved.
FAU - Setianingrum, Findra
AU  - Setianingrum F
AD  - Department of Parasitology, Faculty of Medicine Universitas Indonesia, Jakarta, 
      Indonesia.
AD  - Division of Infection, Immunity and Respiratory Medicine, University of 
      Manchester, Manchester, UK.
FAU - Rautemaa-Richardson, Riina
AU  - Rautemaa-Richardson R
AD  - Division of Infection, Immunity and Respiratory Medicine, University of 
      Manchester, Manchester, UK.
AD  - National Aspergillosis Centre, Manchester University NHS Foundation Trust, 
      Manchester, UK.
AD  - Manchester Academic Health Science Centre, University of Manchester, Manchester, 
      UK.
FAU - Shah, Rajesh
AU  - Shah R
AD  - Manchester Academic Health Science Centre, University of Manchester, Manchester, 
      UK.
AD  - Department of Cardiology and Cardiothoracic Surgery, Manchester University NHS 
      Foundation Trust, Wythenshawe Hospital, Manchester, UK.
FAU - Denning, David W
AU  - Denning DW
AD  - Division of Infection, Immunity and Respiratory Medicine, University of 
      Manchester, Manchester, UK.
AD  - National Aspergillosis Centre, Manchester University NHS Foundation Trust, 
      Manchester, UK.
AD  - Manchester Academic Health Science Centre, University of Manchester, Manchester, 
      UK.
LA  - eng
GR  - MR/P017622/1/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
RN  - 0 (Antifungal Agents)
SB  - IM
MH  - Antifungal Agents/therapeutic use
MH  - Aspergillus
MH  - Chronic Disease
MH  - Female
MH  - Humans
MH  - Male
MH  - *Neoplasm Recurrence, Local
MH  - Pneumonectomy
MH  - *Pulmonary Aspergillosis/drug therapy/surgery
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Aspergillosis
OT  - Antifungal
OT  - Relapse
OT  - Surgery
EDAT- 2020/05/10 06:00
MHDA- 2021/06/22 06:00
CRDT- 2020/05/10 06:00
PHST- 2019/10/18 00:00 [received]
PHST- 2020/03/17 00:00 [revised]
PHST- 2020/03/20 00:00 [accepted]
PHST- 2020/05/10 06:00 [pubmed]
PHST- 2021/06/22 06:00 [medline]
PHST- 2020/05/10 06:00 [entrez]
AID - 5835265 [pii]
AID - 10.1093/ejcts/ezaa137 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2020 Nov 1;58(5):997-1003. doi: 10.1093/ejcts/ezaa137.