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.