The role of surgery in the treatment of invasive fungal infection in paediatric haematology patients: a retrospective single-centre survey

Authors

  • Simone Cesaro,

    Corresponding author
    1. Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
    2. Pediatric Hematology Oncology, Department of Pediatrics, University of Padova, Padova, Italy
    • Correspondence: S. Cesaro, MD, Pediatric Hematology Oncology, Piazzale L.A. Scuro, 10, Policlinico G.B. Rossi, Verona 37134, Italy.

      Tel: +39 045 812 4931. Fax: +39 045 8124909.

      E-mail: simone.cesaro@ospedaleuniverona.it

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  • Anna Pegoraro,

    1. Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
    2. Pediatric Hematology Oncology, Department of Pediatrics, University of Padova, Padova, Italy
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  • Gloria Tridello,

    1. Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
    2. Pediatric Hematology Oncology, Department of Pediatrics, University of Padova, Padova, Italy
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  • Marta Pillon,

    1. Pediatric Hematology Oncology, Department of Pediatrics, University of Padova, Padova, Italy
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  • Elisa Cannata,

    1. Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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  • Stefano Faggin,

    1. Pediatric Neuro Surgery, Women's and Children's Health Department, University of Padova, Padova, Italy
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  • Giovanni Cecchetto

    1. Pediatric Surgery, Women's and Children's Health Department, University of Padova, Padova, Italy
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Summary

Surgery may improve the control of fungal disease and patient survival. The aim of this study was to report a single-centre experience in using surgery for the treatment of paediatric invasive fungal infection (IFI). From 2001 to 2009, 18 paediatric onco-haematology patients underwent 24 surgical procedures as treatment of IFI. At surgery, severe thrombocytopenia and neutropenia were present in four and one episodes respectively. Complications were one pleural effusion, one pleural effusion and surgical wound infection, one pneumothorax with wound dehiscence and one wound dehiscence. None of them required repeat surgery. The median duration of hospitalisation for four complicated procedures was 11 days, range 3–16, and 7 days, range 2–13, for the 20 uncomplicated procedures. No surgery-related deaths occurred. Fourteen patients resumed chemotherapy after a median of 26 days, range 9–77, whereas nine patients underwent hematopoietic stem cell transplantation after a median of 42 days, range 27–110. At 3 months from IFI, 17 patients were alive (94%) and one patient (6%) died from mycosis; the 3-month overall survival (OS) being 94.4%, CI 66.6–99.2. After a median follow-up of 7.1 years (CI 2.8–7.5), the OS was 54.5%, CI 29.2–74.2. Surgery is a feasible and valuable option in paediatric patients because it is associated with a low incidence of complications and an acceptable delay in resuming the chemotherapeutic plan.

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