Is video-assisted thoracic surgery a versatile treatment for both simple and complex pulmonary aspergilloma?

Pulmonary aspergilloma (PA) is a common fugal infectious disease mostly occurred in developing countries. This study aims to evaluate the outcomes of video-assisted thoracic surgery (VATS) treatment for simple pulmonary aspergilloma (SPA) and complex pulmonary aspergilloma (CPA).

From October 2009 to March 2013, 16 patients were treated by VATS for PA in our department. The patients were divided into SPA group and CPA group. Records were retrospectively reviewed and data were collected and compared.

Patients had a median age of 52.8 years [95% confidence interval (CI): 47.8-57.9 years]. The most common symptom was hemoptysis (68.7%) in our patients. The underlying lung diseases were tuberculosis (31.1%), bronchiectasis (12.5%) and pneumatocele (6.2%). All patients received successful lesion resection by VATS, none was converted to thoracotomy. No significant difference was found in terms of sex and age. Patients with CPA tent to have larger lesion (P=0.001) and more intraoperative findings (P=0.003), they also needed longer operative time (P=0.016) and more blood loss (P=0.003). In addition, CPA patients had more volume of drainage after surgery (P=0.005), longer duration of drainage ((P=0.007) and length of stay in hospital (P=0.004). No difference was found in postoperative complications between the two groups.

SPA patients are the best candidates for VATS, but comprehensive measure should be taken for the overall benefit of CPA patients before conducting VATS.