COVID associated pulmonary mucormycosis: Outcomes of surgical therapy

Abstract

Objectives This study aims at reporting the surgical outcomes of COVID associated pulmonary mucormycosis with special emphasis on surgical mortality. Methods This prospective observational study was conducted in a dedicated thoracic surgical unit in Gurugram, India over 18 months. An analysis of demography, peri-operative variables were carried out. Various parameters were analysed to assess the factors affecting mortality. Results Total of 44 patients with diagnosis of CAPM were managed during the study period. All were started on anti-fungal therapy. However, 33 patients (75%) were operated whereas rest 11 (25%) were not considered suitable for surgery. In the surgical cohort ( n = 33), there were 20 males (60.6%) and 13 females (39.4%), with a mean age of 54.8 years (range, 33–72 years). The mean duration of the symptoms was 1.1 weeks. Non-anatomical wedge resection of lobe(s) was performed in 5 patients (15.1%), lobectomy/bi-lobectomy was required in 26 patients (78.9%) and left pneumonectomy in 2 patients (6%). There were 5 peri-operative deaths (15.1%), all due to fungal sepsis. ECOG scale > 2 ( P ≤ 0.001), higher Charlson Comorbidity Index score > 2 ( P = 0.04) and pneumonectomy ( P = 0.02) were the predictors of mortality. On comparison with NCPM, there was no difference in the incidence of post-operative complications ( P = 0.50) and the post-operative mortality ( P = 0.69). Conclusion Aggressive surgical resection with clear margins should be offered in CAPM, whenever feasible. Surgery for CAPM was not associated with higher post-operative complications including mortality compared to Non-COVID Pulmonary Mucormycosis.