Invited Commentary

Abstract

Aspergillosis is a ubiquitous infection caused by the Aspergillus species. Pulmonary aspergilloma is the most frequently diagnosed aspergillosis and there has been an increase in the number of cases, especially in developing countries. The most important symptom of pulmonary aspergillosis is hemoptysis, which is why surgical treatment has sometimes been selected as the treatment for pulmonary aspergilloma. Because the surgical treatment for pulmonary aspergilloma is associated with high postoperative morbidity and mortality rates, the procedures used for the surgical treatment of pulmonary aspergilloma remain challenging. The authors demonstrate that video-assisted thoracic surgery (VATS) has evolved in the last decade and is now a new choice for the surgical treatments of pulmonary aspergilloma. Dr Q-K Chen and colleagues [1Chen Q.-K. Chen C. Chen X.-F. Jiang G.-N. Video-assisted thoracic surgery for pulmonary aspergilloma: a safe and effective procedure.Ann Thorac Surg. 2014; 97: 218-223Scopus (27) Google Scholar] retrospectively reported the results of 76 patients with pulmonary aspergilloma who underwent an attempted VATS lobectomy and compared them to 76 patients selected by propensity score matching from 310 patients with thoracotomy. They showed that the VATS group had a shorter hospital stay and fewer complications compared with those in the thoracotomy group, indicating that the VATS can be an alternative to open procedures that could be used for the management of pulmonary simple aspergilloma (SPA) and localized complex aspergilloma (CPA) without infiltration of the hilum. In this study, the authors selected the candidates for VATS based on the following: young patients with aesthetic demands; no severe parenchymal and pleural scarring, and no calcified lymph nodes near pulmonary arteries and veins based on computed tomographic (CT) scans; and CT scan image findings showing SPA or localized CPA. This indicates not only good indications for VATS but a bias toward the patients who would undergo VATS. To rule out any bias that may be associated with this study, further studies should be prospectively performed. Pulmonary aspergilloma lesions that require a pneumonectomy still remain a major challenge for VATS. Although the authors note that aspergilloma lesions with infiltration of the hilum require a pneumonectomy, no explanation was made with regard to the conditions of 3 patients for pneumonectomy. In addition, in a case that underwent a simple pneumonectomy, which is sometimes not a sufficient surgical modality to cure aspergilloma, extrapleural pneumonectomy is necessary. We wonder if a patient with extrapleural pneumonectomy was included in the patients with pneumonectomy and if the authors could explain the propriety to use the propensity score which made a control group. In conclusion, the most important point of the present study is that VATS is safe and effective for the treatment of pulmonary aspergilloma in selected patients, and the VATS procedure may therefore be a useful surgical modality for the treatment of patients with pulmonary aspergilloma who meet the above-mentioned criteria. Video-Assisted Thoracic Surgery for Pulmonary Aspergilloma: A Safe and Effective ProcedureThe Annals of Thoracic SurgeryVol. 97Issue 1PreviewA variety of complications occur in patients with pulmonary aspergilloma. The safety and feasibility of a thoracoscopic approach to therapeutic lung resection for pulmonary aspergilloma have not been well evaluated. Full-Text PDF