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Surgery for pulmonary aspergillosis
A Csekeo1, L Agócs, M Egerváry
1Koranyi National Institute, Thoracic Surgery Clinic and Pathology Department, Budapest, Hungary.
Objective:
Surgery of pulmonary aspergillosis followed by higher incidence of post-operative complications. This was the purpose to evaluate our material.
Methods:
Between January 1983 and December 1995, the operation was carried out on a total of 84 patients for pulmonary aspergillosis. The patients were comprised of 71 males and 13 females, with a mean age of 49 years (range, 24-71). Previous lung disorders were observed in about half of the cases (most frequently tuberculosis), while in the other half aspergillosis was developed on the basis of (sub)-acute infections. Haemoptysis was present in 48% of patients. The diagnosis was suspected in 47 cases by chest X-ray. Aspergilloma was diagnosed in 50 patients pre-operatively (excluding 12 typical aspergillomas for cavernostomies), with the other pre-operative diagnoses being tuberculosis, lung cancer, pyoscelrosis, etc.
Results:
In 71 cases pulmonary resection was carried out (52 lobectomies, 13 wedge resections and six pulmonectomies). A total of 12 cavities were opened by cavernostomy and one lung biopsy was performed for disseminated lung disease. The post-operative mortality rate was 9.5%. The most common complications were bleeding, empyema, bronchial fistula and wound infection. In 23 patients with developed prolonged air leak and/or residual air space, complications were observed more frequently in patients with greater cavitation near the chest wall.
Conclusions:
In most cases of pulmonary aspergilloma surgical intervention remains the only effective therapy. The operation has a lower risk factor in asymptomatic patients and in patients without pleural or chest wall involvement. In some cases, cavernostomy may be the only remaining surgical choice.
Insights
Surgical intervention for pulmonary aspergillosis can lead to complications. This study evaluates surgical outcomes for 84 patients, highlighting resection as a primary treatment for pulmonary aspergilloma.
Area of Science:
- Medical Mycology
- Thoracic Surgery
- Infectious Diseases
Background:
- Pulmonary aspergillosis presents a significant challenge, often associated with a high incidence of post-operative complications.
- Understanding surgical outcomes is crucial for managing this invasive fungal infection.
Purpose of the Study:
- To evaluate surgical outcomes and complications in patients with pulmonary aspergillosis.
- To assess the effectiveness of surgical intervention as a primary treatment for pulmonary aspergilloma.
Main Methods:
- A retrospective analysis of 84 patients undergoing surgery for pulmonary aspergillosis between 1983 and 1995.
- Data collected included patient demographics, pre-operative diagnoses (e.g., aspergilloma, tuberculosis), diagnostic methods (chest X-ray), and surgical procedures (pulmonary resection, cavernostomy).
Main Results:
- Pulmonary resection was performed in 71 patients; cavernostomy in 12.
- The post-operative mortality rate was 9.5%, with common complications including bleeding, empyema, bronchial fistula, and wound infection.
- Complications were more frequent in patients with larger cavities near the chest wall.
Conclusions:
- Surgical intervention remains the primary effective therapy for most cases of pulmonary aspergilloma.
- Asymptomatic patients without pleural or chest wall involvement have a lower surgical risk.
- Cavernostomy may be the only viable surgical option in select cases.