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Ann Thorac Surg. 2014 Feb;97(2):432-8. doi: 10.1016/j.athoracsur.2013.10.050. Epub 2013 Dec 21.

Surgical therapy of pulmonary aspergillomas: a 30-year North American experience.

Author information

1
Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: amuniappan@partners.org.
2
Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.

Abstract

BACKGROUND:

Pulmonary aspergilloma is resected to control life-threatening complications such as massive hemoptysis. The role of prophylactic resection in asymptomatic patients is unclear.

METHODS:

A retrospective review was conducted of 60 patients treated at a tertiary center from 1980 to 2010.

RESULTS:

The mean age in 34 (56.7%) men and 26 (43.3%) women was 51 years. Immunosuppression, most commonly from chronic steroid use, was present in 17 (28.3%) patients, and preexisting lung disease was present in 47 (78.3%) patients. Hemoptysis occurred in 33 (55%) patients, whereas 9 (15.0%) patients were asymptomatic. Aspergilloma was simple in 13 (21.7%) patients and complex in 47 (78.3%) patients. Surgical approach was by thoracotomy (n=51 [85.0%]), video-assisted thoracoscopic surgery (n=7 [11.7%]), or a cavernostomy (n=2 [3.3%]). Sublobar resections (n=28 [46.7%]) were most common, followed by lobectomy (n=27 [45%]) and pneumonectomy (n=3 [5%]). Postoperative morbidity occurred in 18 (30%) patients, with prolonged air leak the most frequent complication (n=9 [15%]). Two (3.3%) patients experienced empyema, and 4 (6.7%) patients had bronchopleural fistulas (BPFs). Two patients died within 30 days (3.3%). During a mean follow-up of 54.1±62.2 months, 3 patients had recurrent aspergillomas (5.0%). Actuarial 10-year survival was 62.5% for simple and 68.5% for complex aspergillomas (p=0.858). Comorbid conditions (human immunodeficiency virus [HIV] positivity, malignancy) and male sex were associated with lower survival.

CONCLUSIONS:

Selective surgical treatment favoring lesser pulmonary resection results in fungal eradication and control in most patients. Overall survival is similar after surgical management of simple and complex aspergillomas.

KEYWORDS:

11

[Indexed for MEDLINE]

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