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Aspergilloma: a series of 89 surgical cases
J F Regnard1, P Icard, M Nicolosi
1Department of Thoracic Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France.
Background:
Surgery for pleuropulmonary aspergilloma is reputed to be risky. We reviewed our results, focusing attention on the postoperative complications.
Methods:
During a 20-year period, 87 patients were operated on for pulmonary (86) or pleural (3) aspergillomas. Seventy-two percent of patients were complaining of hemoptysis. Eighty-nine resections were performed because there were two bilateral cases. Seventy percent of aspergillomas had developed in cavitation sequelaes from tuberculosis disease. Thirty-four patients had severe respiratory insufficiency that allowed us to perform only lobectomy (18), segmentectomy (2), or cavernostomy (14).
Results:
Thirty-seven lobectomies (five with associated segmentectomies), two bilobectomies, 21 segmentectomies, 10 pneumonectomies, and 17 cavernostomies were performed. Total blood loss exceeded 1,500 mL in 14 cases, and 71% of patients required blood transfusion. There were five postoperative deaths (5.7%), related to respiratory failure (2), infectious complication (1), pulmonary embolus (1), and cardiorythmic disorder (1). Incomplete reexpansions were frequently seen in patients undergoing lobectomies or segmentectomies. No death or major complications occurred in asymptomatic patients. During follow-up, none of the patients had recurrent hemoptysis.
Conclusions:
Surgical resection of aspergilloma is effective in preventing recurrence of hemoptysis. It has low risk in asymptomatic patients and in the absence of underlying pulmonary disease. Incomplete reexpansion is frequent after lobectomy and segmentectomy, especially when there is underlying lung disease. Cavernostomy is an effective treatment in high-risk patients. Long-term prognosis is mainly dependent on the general condition of patients.
Insights
Surgical resection effectively treats pulmonary aspergilloma, preventing hemoptysis recurrence. The procedure is low-risk for asymptomatic patients without lung disease, but high-risk patients may benefit from cavernostomy.
Area of Science:
- Pulmonology
- Thoracic Surgery
- Infectious Diseases
Background:
- Pleuropulmonary aspergilloma surgery is considered high-risk.
- A review of surgical outcomes focused on postoperative complications.
Purpose of the Study:
- To evaluate the safety and efficacy of surgical resection for pleuropulmonary aspergilloma.
- To identify risk factors for postoperative complications and long-term outcomes.
Main Methods:
- Retrospective review of 87 patients undergoing surgery for pulmonary or pleural aspergillomas over 20 years.
- Analysis of surgical procedures, including lobectomy, segmentectomy, pneumonectomy, and cavernostomy, and associated patient characteristics.
- Evaluation of postoperative complications, mortality, and long-term recurrence rates.
Main Results:
- 89 resections were performed; 70% of aspergillomas were in tuberculosis sequelae.
- Postoperative mortality was 5.7% (5 deaths), primarily due to respiratory failure.
- Incomplete lung reexpansion was common after lobectomy/segmentectomy, especially with underlying lung disease. No deaths occurred in asymptomatic patients.
Conclusions:
- Surgical resection is effective for preventing recurrent hemoptysis in aspergilloma patients.
- Asymptomatic patients without underlying lung disease have a low surgical risk.
- Cavernostomy is a viable option for high-risk patients; long-term prognosis depends on overall patient condition.