Surgical Treatment of Invasive Fungal Infection in Pediatric Oncology

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.