J Thorac Dis. 2026 May 31;18(5):521. doi: 10.21037/jtd-2026-1-0386. Epub 2026 May 27.
ABSTRACT
BACKGROUND: Pulmonary resection is an important adjunct to antifungal therapy in selected patients with Aspergillus-related lung disease. However, the impact of surgical margin status on treatment outcomes remains poorly defined. The objective is to compare the impact of surgical margins on treatment response in patients with pulmonary fungal infections, analyzing persistence of symptoms, perpetuation of fungal colonization, and disease recurrence.
METHODS: This retrospective study analyzed patients treated between 2020 and 2024 with inflammatory/infectious pulmonary diseases caused by Aspergillus, undergoing pulmonary resection due to complications or as an adjunct to clinical treatment with curative intent. Patients were divided into two groups: tangential margin (distance to pulmonary margin <0.1 cm) and non-tangential margin (distance >0.1 cm). Patients were followed for one year. Exclusion criteria included incomplete records, loss to follow-up, or pneumonectomy cases.
RESULTS: Nineteen patients were included, of whom four experienced disease recurrence. All recurrence cases occurred in the “tangential margin” group. Tangential margins were strongly associated with symptom persistence, with an odds ratio (OR) of 11.0 [95% confidence interval (CI): 1.30-140.9, P=0.04]. Patients in this group also showed a smaller reduction in Aspergillus serology titers (50%) compared to the “non-tangential margin” group (75%), with statistical significance (P=0.04). The study also examined the correlation between the extent of lung disease and treatment outcomes but found no statistically significant association with recurrence, symptom persistence, or serology titer reductions.
CONCLUSIONS: As lung-sparing surgeries become more prevalent, an adequate surgical margin remains critical to achieving disease-free survival. This study suggests the importance of ensuring sufficient margins in pulmonary resections for fungal infections to optimize therapeutic outcomes. Additional research is needed to confirm our findings.
PMID:42306664 | PMC:PMC13266717 | DOI:10.21037/jtd-2026-1-0386
