Surgical Treatment Of Pulmonary Aspergilloma Research Articles

Factors affecting survival after anatomical lung resection in pulmonary aspergilloma: Our 10-year single institution experience.

Background The aim of this study was to investigate the long-term outcomes of patients who underwent anatomic lung resection for pulmonary aspergilloma and to evaluate the prognostic factors affecting early postoperative morbidity. Methods Between January 2007 and January 2017, we retrospectively evaluated a total of 55 patients (40 males, 15 females; mean age: 44.6 years; range, 18 to 75 years) who underwent lobectomy and pneumonectomy for pulmonary aspergilloma. All patients were evaluated for simple or complex aspergilloma based on imaging and thoracotomy findings. Results Thirty-two (58.2%) patients presented with hemoptysis. Seven (12.7%) patients underwent emergency surgery due to massive hemoptysis. Postoperative morbidity was observed in 15 (27.3%) patients. Prognostic factors that had an effect on morbidity were resection type, Charlson Comorbidity Index >3, and massive hemoptysis (p<0.05). There was no intra- or postoperative mortality. The five-year survival rate was 89.4%. None of the factors evaluated in the study were associated with survival. Conclusion The main finding of this study is the absence of mortality after surgical treatment for pulmonary aspergilloma. The success of surgical treatment depends on the management of postoperative complications.

Surgical Treatment of Pulmonary Aspergilloma: A 13-year Experience From a Single Clinical Center

BackgroundPulmonary aspergilloma is chronic and invasive, potentially leading to life-threatening massive hemoptysis. The role of surgery for treating pulmonary aspergilloma and its effect on long-term survival needs more study. MethodsWe reviewed 166 patients with aspergillomas treated at Shanghai Pulmonary Hospital from 2004 to 2017. Surgery indications included destroyed lung parenchyma, recurrent hemoptysis, despite appropriate medical treatment, and isolated pulmonary nodules suspected to be aspergilloma. Pulmonary aspergillomas are classified as simple (in an isolated thin-walled cavity, ≤3 mm) or complex (a thick-walled cyst, >3 mm) based on computed tomographic scan findings. ResultsAspergilloma was complex in 100 patients (60.2%) and simple in 66 (39.8%). The median (interquartile range) size of complex aspergillomas (2.5 [0.3-8.0] cm) was larger than that (2.0 [0.2-6.0] cm) of simple types (P < .001). Hemoptysis occurred in 72 patients (72%) with complex disease and in 35 (53%) with simple disease (P = .014). Video-assisted thoracoscopic surgery was performed in 42 patients (63.6%) with simple aspergillomas, and 75 patients (75%) with of complex aspergillomas underwent thoracotomy. Prolonged air leakage (>7 days) was the most common (17 [10.2%]) postoperative complication. A bronchopleural fistula developed postoperatively in 1 patient (0.6%). One patient (0.6%) died of respiratory failure within 30 days postoperatively. Two patients (1.2%) experienced recurrence during follow-up. The overall 10-year survival rates were 87.7% for complex aspergillomas and 94.97% for simple aspergillomas (P = .478). Diabetes (12 [7.2%]; hazard ratio, 13.15; 95% CI, 1.12-154.46) was associated with a worse prognosis. ConclusionsThe perioperative morbidity and mortality of pulmonary aspergillomas are acceptable. Overall survival rates of simple and complex types are comparable.

Aspergiloma como sequela de tuberculose pulmonar: relato de caso

Objetivo: Relatar um caso de aspergiloma como sequela de tuberculose pulmonar em um paciente jovem e imunocompetente. Relato de Caso: Paciente masculino, 24 anos, trabalhador rural. Admitido em hospital para tratamento cirúrgico do aspergiloma pulmonar, apresentando quadro de tosse seca há quatro meses associada a episódios de hemoptise volumosa. Histórico de tuberculose pulmonar no ano anterior adequadamente tratada. Trazia tomografia de tórax revelando lesão escavada de paredes espessas, no segmento apicoposterior do lobo superior esquerdo, contendo nodulação sólida de contornos bocelados no interior, móvel à mudança de decúbito, sugerindo colonização fúngica sobrejacente. Trazia ainda baciloscopia de escarro e sorologias anti-HIV 1 e 2 negativas. Relatou tratamento com Itraconazol 200mg 12/12 horas por 20 dias há cerca de dois meses, sem melhora clínica. Durante internação foi submetido à lobectomia superior esquerda. Admitido em CTI no pós-operatório imediato, onde permaneceu por três dias. Paciente apresentou boa evolução, seguido por alta hospitalar no nono dia pós-operatório. Considerações Finais: O aspergiloma pulmonar deve ser considerado em todos os pacientes com história de alteração da arquitetura pulmonar, especialmente àquelas produzida por tuberculose, que apresentem uma história respiratória caracterizada por hemoptise. Considera-se o tratamento cirúrgico como primeira escolha incluindo em pacientes assintomáticos.

Surgical Treatment of Pulmonary Aspergilloma

Introduction: Surgical approaches for the management of pulmonary aspergilloma have been accompanied with high levels of morbidity and mortality. However, these therapeutic options are still favored over other approaches for the treatment of Pulmonary Aspergilloma. In this study, we aimed to describe the characteristics of 30 patients with aspergilloma who referred to Ghaem hospital between 2017-2018 and describe their results. Materials and Methods: This retrospective study was conducted on 30 patients (i.e., 21 males and 9 females) with pulmonary aspergilloma who were treated via surgery. The patients were examined based on their age, gender, clinical symptoms prior to surgery, affected pulmonary lobe, surgical method, and postoperative complications. Results: The mean age of the patients was 48.13(5.2) years. Hemoptysis (90%) was the most common symptom of pulmonary aspergilloma, followed by productive cough and drug-resistant pneumonia. The most common problematic lobes included left upper lobe and right upper lobe. Regarding the surgical method, 21 and 9 patients underwent lobectomy and segmentectomy, respectively. After the surgery, residual space, wound infection, ad bronchopleural fistula was observed in 5 (16.7%), 3 (10%), and 2 (6.7%) cases, respectively. Furthermore, only one patient passed away. Conclusion: As the findings indicated, the methods of surgery (i.e., lobectomy and segmentectomy) showed effective treatment for patients.

Surgical treatment for pulmonary aspergilloma in seventeenth years old female: case report

Aspergillosis is defined as a mycosis group caused by various pathogenic fungi of the Aspergillus genus. Aspergillus has more than 900 species that cause infection in human. The most common Aspergillus species that cause infection is Aspergillus fumigatus, about 90%. Other species, Aspergillus flavus, about 10% cause invasive disease. Have been reported a young girl 17-year-8-month-old woman was admitted to emergency with complaints of coughing up blood. The patient has diagnosed an aspergilloma and treated with thoracotomy bi-lobectomy right lower lung based on thorax scan. The patient took Fluconazole and surgical bilobectomyfor treated the aspergilloma and got improvement.

Surgical treatment for pulmonary aspergilloma - early and long-term results.

IntroductionPulmonary aspergilloma is a difficult therapeutic problem due to the low effectiveness of conservative treatment and high surgical morbidity.AimTo analyze the early and late results of surgical treatment for pulmonary aspergilloma.Material and methodsFrom 2005 to 2015, 49 patients were treated surgically for pulmonary aspergilloma. Symptoms occurred in 85.7% of cases, including recurrent hemoptysis in 53%. A history of immunosuppressive therapy or chemotherapy was noted in 24.5% of patients. Complex aspergilloma was diagnosed in 79.6% of cases. Immunological test results were positive in 10.2%, and bronchoalveolar lavage samples were positive for Aspergillus species in 18.5% of cases. In 59.2% of patients, the surgical risk was assessed as ASA 3. Thirty seven patients underwent lobectomy, 3 – pneumonectomy, 7 – wedge resection, 1 – decortication, and 1 – cavernostomy.ResultsIn-hospital mortality was 4.1%. Postoperative complications occurred in 63.3% of patients. The most common complications were: prolonged air leak (26.3%), arrhythmias (20.4%), residual pneumothorax (16.3%), respiratory failure (14.3%), atelectasis (12.3%), and bleeding (12.3%). Of the three patients that underwent pneumonectomy, one died, two required repeat thoracotomy because of bleeding, and all three required prolonged mechanical ventilation. Two patients died during the follow-up period. Aspergilloma did not recur in any of the patients who underwent pulmonary resection.ConclusionsDue to the high risk of complications, surgical treatment of pulmonary aspergilloma should be restricted to symptomatic patients in whom lobectomy can be performed. The long-term results of surgical treatment are good, preoperative symptoms abate in most patients, and the rate of aspergillosis recurrence is very low.

Surgical treatment of pulmonary aspergilloma: a single-center experience

Aspergillus fumigatus is a saprophytic fungus which colonizes in the cavitary lesions in the lungs. In our part of the world, where tuberculosis is endemic, the healed tubercular cavities form a good nidus for this fungus. The fungus forms a fungal ball or aspergilloma within the cavity which erodes the walls of the cavity and causes hemoptysis by erosion of the bronchial vessels. Hemoptysis is the main symptom for which patients seek medical attention. Antifungal agents are not useful against the fungal ball. Surgery in the form of lobectomy is the primary treatment. Surgery for aspergilloma is known to be risky because of intrapleural adhesions, obliteration of the interlobar fissures, massive hemorrhage during dissection, and poor pulmonary reserve of the patient due to the underlying disease. Clinical presentation, radiological investigations, operative techniques, postoperative outcome, and follow up of 24 cases of pulmonary aspergilloma treated surgically were studied prospectively between August 2010 and July 2013 at IPGMER & SSKM Hospital, Kolkata. There were 15 male (62.5 %) and 9 female (37.5 %) patients in this series. Mean age of the study population was 34.54 years. All the patients had complex aspergilloma. Tuberculosis was the underlying disease in 22 patients (91 %). The mean duration from first diagnosis of tuberculosis to the diagnosis of aspergilloma was 3.4 years. Hemoptysis was the main symptom in 79.16 % cases. Chest x-ray was the first investigation which gave a clue to the diagnosis. Computed tomography scan was diagnostic in all cases delineating the location of the pulmonary cavity along with the aspergilloma inside it and the characteristic air crescent sign. Right upper lobe was involved in 13 patients (54.16 %) and left upper lobe was involved in 11 patients (45.84 %). Lobectomy was done in 16 patients (66.67 %), segmentectomy in 4 patients (16.66 %), and pneumonectomy in 4 patients (16.66 %). There was one mortality, and the overall complication was 33.33 %. The average follow-up period was 21.65 months, during which there was no mortality and no recurrence of hemoptysis in these patients. Though surgery for aspergilloma is considered to be risky, excision of the cavity along with the involved lobe can be done with acceptable morbidity and mortality to provide the patient complete cure and symptom-free survival.

Results of surgical treatment for pulmonary aspergilloma

Aspergilloma results from the development, inside preexisting pulmonary cavities, of aspergillus spores. It is most commonly manifested by hemoptysis. The goal of this retrospective study is to report our surgical experience of this disease. From January 2004 to December 2008, 35 patients underwent surgery at the same center for pulmonary aspergilloma. We examined the epidemiological, clinical, paraclinical, therapeutic, and outcome data. The patients' median age was 43.37 years (range: 20-70 years), 28 were male. The average time to consultation was 19.35 months (1-120 months), and all patients had a history of pulmonary tuberculosis. Hemoptysis was the symptom observed most often, in 54.3% of patients, followed by bronchorrhea. Aspergillus serology was positive for 22 patients. The standard radiological image was found in 20 patients. We performed 14 lobectomies, 1 bilobectomy, 1 segmentectomy, 1 bisegmentectomy, 3 lobectomies with segmentectomies, 1 bilobectomy with segmentectomy, and 14 pleuropneumonectomies. In one case, the pulmonary artery was damaged and repaired. The average duration of intensive care was 3.54 days (2-7 days) and of total hospitalization, 17.33 days (7-48). Complications were: empyema (3 cases), a large air leak (1 case), parietal suppuration (5 cases), and pleural effusion, which was drained (3 cases). There was no postoperative mortality. After 35 months (1-72), one case of recurrent hemoptysis by reinfestation was observed. Three patients died of respiratory failure, one at 6 months and the other two at 1 year after the surgery. Despite the associated morbidity, surgical treatment of pulmonary aspergilloma must be proposed systematically to these subjects presenting hemoptysis.

Invited Commentary

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

Surgical treatment for pulmonary aspergilloma: a 35-year experience in the Chinese population

The surgical treatment of pulmonary aspergilloma is challenging and controversial. This study was designed to evaluate the clinical profile, indications and surgical outcomes of pulmonary aspergilloma operated on in our institute. A total of 256 patients with pulmonary aspergilloma underwent surgical treatment from 1975 to 2010. The patients were divided into two groups: Group A (simple aspergilloma, n = 96) and Group B (complex aspergilloma, n = 160). The principal underlying lung disease was tuberculosis (71.1%). The surgical procedures consisted of 212 lobectomies in both groups; eight cavernoplasties, 10 bilobectomies, 16 pneumonectomies and six thoracoplasties in Group B; four segmentectomies and six wedge resections in Group A. Postoperative complications occurred in 40 patients (15.6%). The major complications were residual pleural space (3.9%), prolonged air leak (3.1%), bronchopleural fistula (1.6%), excessive bleeding (1.6%), respiratory insufficiency (1.9%) and empyema (1.2%). No intraoperative deaths occurred. The overall mortality within 30 days post-operation was 1.2%, occurring only in Group B. There was no statistically significant difference in the postoperative morbidity between Groups A and B (P = 0.27). With the good selection of patients, meticulous surgical techniques and good postoperative management, aggressive surgical treatment with anti-fungal therapy for pulmonary aspergilloma is safe and effective, and can achieve favourable outcomes.

Results of surgical treatment for pulmonary aspergilloma with 26 cases in six years: a single center experience

Surgery for pulmonary aspergilloma is reputed to be risky. We analyzed our results of the surgical treatment for pulmonary aspergilloma. Between 2003 and 2009, 26 patients underwent thoracotomy for treatment of pulmonary aspergilloma in our center. Results were evaluated retrospectively. There were 5 female and 21 male patients, with a mean age of 44 ± 11.6 years (28-70). The patients were divided into two groups, group A (simple aspergilloma; n= 8) and group B (complex aspergilloma; n= 18). Major underlying diseases were tuberculosis (61.5%). The most common indication for operation was hemoptysis (57.6%). Of our patients, 23% were complaining of massive hemoptysis or recurrent hemoptysis. Other patients were complaining of mild symptoms and some of them were totally asymptomatic. We performed 15 (57.6%) lobectomies (3 with associated segmentectomies), 8 (30.6%) segmentectomies/wedge resections, 2 (7.6%) pneumonectomies, and 1 (3.8%) cavernoplasty. Postoperative complications occurred in 15 (57.6%) patients. Complications occurred in 72.2% patients of complex aspergilloma, whereas 25% occurred in simple aspergilloma (p= 0.03). Major complications included prolonged air leak, empyema, air space. One patient who underwent lobectomies for complex aspergilloma developed bronchopleural fistula and died of respiratory failure on the 20th postoperative day. Operative mortality was 3.8%. The average postoperative hospital stay was 12.9 days. The mean follow-up period was average 44 months. The actuarial survival at 3 years was 90% and 100% for complex aspergilloma and simple aspergilloma, respectively (p> 0.05). There was two recurrence of disease (8%). But no recurrence of hemoptysis. Low morbidity rate may have been due to the selection of patients with localized pulmonary disease in this study. Surgical resection of asymptomatic or symptomatic pulmonary aspergilloma is effective in preventing recurrence or massive hemoptysis for patients whose condition is fit for pulmonary resection with reasonable mortality, morbidity and survival rates.

Tratamento cirúrgico de aspergiloma pulmonar

The objective of this study was to analyze the outcome of surgical treatment of pulmonary aspergilloma. To that end, we evaluated 14 adult patients so treated between 1981 and 2009 at the Botucatu School of Medicine University Hospital, in the city of Botucatu, Brazil. Data were collected from the medical records of the patients. Ten patients (71%) presented with simple pulmonary aspergilloma, and 4 (29%) presented with complex pulmonary aspergilloma. Hemoptysis was the most common symptom, and tuberculosis was the most prevalent preexisting lung disease. Two patients (14%) underwent surgery on more than one occasion. There were no intraoperative deaths. Half of the patients developed postoperative complications, prolonged air leak and empyema being the most common.

Predictive and Prognostic Value of Preoperative Symptoms in the Surgical Treatment of Pulmonary Aspergilloma

Surgical resection is widely accepted as the treatment of choice for pulmonary aspergilloma (PA). However, the technique involved ranks among the most challenging in thoracic surgery and remains associated with considerable morbidity and mortality. To improve the outcomes, it is essential to establish clear recommendations for optimal timing of surgery and selection of patients. To facilitate this, we analyzed the impact of preoperative clinical factors on the results of treatment. Medical records of patients treated surgically for PA between 1979 and 2007 were retrospectively reviewed for clinical variables of potential impact on the surgical outcome with emphasis on preoperative symptoms. Sixty-four patients, including 22 cases of simple aspergilloma and 42 cases of complex aspergilloma were enrolled in the study. Univariable analysis followed by multivariable logistic regression identified weight loss and massive hemoptysis as risk factors for postoperative morbidity [odds ratio (OR) = 8.856, P = 0.006 and OR = 6.9, P = 0.021, respectively]. Ten-year cumulative survival in simple aspergilloma and complex aspergilloma was 88.3% and 70.6%, respectively (P = 0.042). Multivariable analysis by Cox proportional hazard model showed that younger age and lack of massive hemoptysis were independent favorable prognostic factors [hazard ratio (HR) = 1.13, P = 0.0004 and HR = 4.71, P = 0.0319, respectively). Massive hemoptysis is an independent unfavorable predictive and prognostic factor in the surgical treatment of PA. We believe that in operable cases, early surgical resection may be recommended even in asymptomatic patients. This strategy may prevent development of life-threatening symptoms and offers a realistic chance of permanent cure with acceptable mortality and morbidity.

Pulmonary aspergilloma: Analysis of prognosis in relation to symptoms and treatment

This study was conducted to assess the risk of surgical treatment and to evaluate surgical resection in patients with pulmonary aspergilloma. We reviewed 240 patients with pulmonary aspergilloma who were diagnosed between 1990 and 2006. Of these, 135 patients underwent surgical procedure (group A) and 105 patients were managed with conservative treatment (group B). Forty complications (29.6%) and 6 operative mortalities (4.4%) developed in group A. During the follow-up period, there were 5 recurrences (3.9%) after surgical procedure. The overall 10-year survival rates of group A and group B were 84.8% and 56.7% (P < .001). In multivariate analysis, age, sex, and surgical treatment were favorable prognostic factors. Symptoms of hemoptysis and blood-tinged sputum were not significant prognostic factor even in univariate analysis. Our results indicate that (1) early morbidity and mortality rates of surgical treatment for pulmonary aspergilloma are acceptable, and (2) surgical treatment is helpful not only to reduce symptoms but also to prolong the survival of patients with pulmonary aspergilloma. Although more studies are needed, our data support the conclusion that surgical resection should be considered for all patients with pulmonary aspergilloma who have acceptable pulmonary reserve.

Surgical outcome of pulmonary aspergilloma

Surgical resection offers the only realistic chance of permanent cure for pulmonary aspergilloma. This prospective study was designed to evaluate our indications and surgical outcome of pulmonary aspergilloma with analysis of postoperative complications. Between 2001 and 2008, 42 patients underwent surgical treatment for pulmonary aspergilloma at Zagazig University Hospital. The patients were divided into two groups, group A (simple aspergilloma) n=12 and group B (complex aspergilloma) n=30. Group A consisted of eight male and four female patients with a mean age of 43+/-11.3 years. Group B consisted of 20 male and 10 female patients with a mean age of 46+/-12 years. The most common presentation and indication for surgery was hemoptysis (83.3%) in both groups. The common underlying lung diseases were tuberculosis (40.4%), bronchiectasis (33.3%) and lung abscess (11.9%). The common surgical procedure performed was lobectomy (85.7%), followed by pneumonectomy (6.7%), segmentectomy (8.3%), cavernoplasty (4.7%) and bilobectomy (6.7%). The postoperative mortality was 3.3% in group B only. Postoperative non-fatal complications occurred in 12 patients (28.5%) in both groups. The complications included prolonged air leak (2.3%), bleeding (4.7%), wound infection (2.3%), empyema (7.1%), bronchopleural fistula (2.3%) and one patient developed chylothorax after lobectomy (2.3%). The mean follow-up period was (25.5+/-17 months). The survival rate at 5 years was 91.6% and 83.3% in group A and group B respectively and there was no recurrence of disease or hemoptysis. Surgical treatment of pulmonary aspergilloma is the most effective treatment; pulmonary resection is the treatment of choice when indicated and in unstable surgical patients, palliative procedures chosen in bad cardiopulmonary function.

Chirurgie des aspergillomes pulmonaires

The purpose of this study was to report the results of surgical treatment of pulmonary aspergilloma in 278 consecutive patients in a hospital using surgical treatment systematically when possible to avoid potentially fatal bleeding. Diagnosis required morphological assessment as well as testing of sputum and blood samples. Preoperative studies also included pulmonary function tests for all patients. Surgical intervention was systematic, for treatment or diagnostic purposes. The incision of choice was a standard posterolateral thoracotomy via the 5th intercostal space. Mycological examination of the parenchymatous cavity confirmed the diagnosis. Immediate postoperative surveillance depended on clinical, radiologic, and laboratory findings as well as pleural drainage. Postoperative clinical and radiographic follow-up took place during the first month, the third month and then every 6 months. Between 1982 and 2004, our thoracic surgery department saw 320 cases of pulmonary aspergilloma. In all, 278 patients (161 men and 117 women) underwent pulmonary resection. The mean age was 32 years (range: 16-70 years). The principal underlying disease was tuberculosis (73%), and the most common symptom hemoptysis (83%). Treatment was exclusively surgical in all patients, and there were 279 resections because one patient had staged bilateral segmentectomy. Resections included 130 lobectomies, 51 segmentectomies, 45 pneumonectomies, 33 lobectomies with segmentectomy, 17 bilobectomies and 3 thoracoplasties. There were 16 postoperative deaths (5.7%), 14 of them in patients who had undergone pneumonectomy. Postoperative complications included empyema (12.5%), incomplete reexpansion (9.3%), postoperative bleeding (5%), respiratory infections (4.6%), respiratory failure (4%), bronchial fistula (2.5%) and wound infections (2%). 12 patients had further surgery: 3 for hemothorax, 2 for empyema and 4 for secondary thoracoplasty. The postoperative course was uneventful for 54.1% of cases. Surgery for pulmonary aspergilloma is difficult and dangerous. It nonetheless remains the treatment of choice of this opportunistic pulmonary mycosis, despite the high risk of postoperative morbidity and mortality.

Analysis of Surgical Treatment for Pulmonary Aspergilloma

Surgery for pulmonary aspergilloma is reputed to be risky. The results of surgical treatment of pulmonary aspergilloma in 41 patients between 1988 and 2003 were evaluated retrospectively. Hemoptysis occurred in 31 patients (75.6%) and it was massive (> 300 mL in 24 hr) in 3. The underlying lung disease was tuberculosis in 35, bullous lung disease in 2, hydatid cyst in 2, and lung carcinoma in 2 patients. Lobectomy, bilobectomy, wedge resection, and pneumonectomy were performed in 27, 4, 6, and 4 patients respectively. The postoperative complication rate was 24.4%. One patient, who had a right pneumonectomy, died due to respiratory failure; the mortality rate was 2.4%. Recurrent hemoptysis was observed in only one patient. Early surgical treatment of patients with pulmonary aspergilloma resulted in a satisfactory outcome with acceptable morbidity, low mortality, and effective prevention of recurrent hemoptysis. Pneumonectomy has a high morbidity, thus it should be avoided if possible.

Results of surgical treatment for pulmonary aspergilloma.

The purpose of this retrospective study is to analyze the results of the surgical treatment for pulmonary aspergilloma and to confirm that aggressive surgical resection can provide effective outcome for these patients. From 1987 to 2000, 110 patients underwent thoracotomy for treatment of pulmonary aspergilloma in two hospitals. The most common indication for operation was hemoptysis (82%). Underlying diseases were tuberculosis (89%), bronchiectasis (5%), carcinoma (3%), lung tumor (1%) and none (2%). The procedures were lobectomy (74%), segmentectomy (12%), wedge resection (9%), pneumonectomy (4%) and cavernoplasty in two patients. Twenty-nine patients (26%) had severe underlying intrathoracic pathologies. Postoperative complications occurred in 23.6% of the patients including: empyema (n=13), bleeding (n=6), respiratory insufficiency (n=2), wound infection (n=4) and bronchopleural fistula (n=1). There was one hospital death due to panperitonitis after gastric ulcer perforation. We recommend early surgical resection of symptomatic aspergilloma and even asymptomatic cases with reasonable complication.

Surgical treatment of pulmonary aspergilloma: Current outcome

Objective: This retrospective study was designed to confirm that aggressive pulmonary resection can provide effective long-term palliation of disease for patients with pulmonary aspergilloma. Methods and results: From 1959 to 1998, 84 patients underwent a total of 90 operations for treatment of pulmonary aspergilloma in the Marie-Lannelongue Hospital. The mean follow-up period was 9 years, and 83% of the patients were followed up for 5 years or until death, if the latter occurred earlier. The median age was 44 years. The most common indications were hemoptysis (66%) and sputum production (15%). Fifteen patients (18%) had no symptoms. Tuberculosis and lung abscess were the most common underlying causes of lung disease (65%). The procedures were 70 lobar or segmental resections, 8 cavernostomies, and 7 pneumonectomies. Five thoracoplasties were required after lobectomy (3 patients) or pneumonectomy (2 patients). The operative mortality rate was 4%. The major complications were bleeding (23 patients), prolonged air leak (31 patients), respiratory failure (10 patients), and empyema (5 patients). The actuarial survival curve showed 84% survival at 5 years and 74% survival at 10 years. During the first 2 years, death was related to the surgical procedure and the underlying disease. In contrast, 85% of the survivors had a good late result. Conclusion: Lobar resection in both the symptomatic and the asymptomatic patients was conducted in low-risk settings. For patients whose condition is unfit for pulmonary resection, cavernostomy may need to be undertaken despite the high operative risk. The better survival rate in this study may have been due to the selection of patients with better lung function and localized pulmonary disease. (J Thorac Cardiovasc Surg 2000;119:906-12)

Surgical treatment for pulmonary aspergilloma: a 28 year experience.

BACKGROUND: Pulmonary aspergilloma has been treated surgically for many years but the mortality rates of larger surgical series, varying from 7% to 23%, is not considered acceptable by today's standards....