Surgery for aspergilloma: time trend towards improved results?

Lejay, Anne; Falcoz, Pierre‐Emmanuel; Santelmo, Nicola; Helms, O.; Кочеткова, Е. А.; My, Jeung; Kessler, Romain; Massard, Gilbert

doi:10.1510/icvts.2011.265553

Cited by 48 publications

(60 citation statements)

References 15 publications

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“…When performed, surgery appeared relatively safe with no reported mortality, and was well tolerated with few complications, in keeping with multiple contemporary studies where mortality rates of <1% were reported. [17][18][19][20][21] Without surgery, mortality was high (5.1%) and comparable to previous studies. [6][7][8][9][10] Our study population was relatively young and predominantly male.…”

Section: Discussionsupporting

confidence: 86%

“…It has the benefits of prevention of lifethreatening haemoptysis, eradication of the pyogenic component and probable prolongation of life. [15][16][17][18][19][20][21] Although surgical resection is considered curative, it is not possible in every patient, for a variety of physiological and technical reasons. Such reasons may include poor physical condition, severe comorbidity, poor pulmonary reserve, extensive lung involvement or inability to localise the bleeding site.…”

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confidence: 99%

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Outcomes of resectable pulmonary aspergilloma and the performance gap in a high tuberculosis prevalence setting: A retrospective study

et al. 2017

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Background. Pulmonary aspergillomas develop in patients with underlying structural lung diseases. The mainstay of therapy is surgery. Objectives. To assess treatment and clinical outcomes following diagnosis of potentially resectable pulmonary aspergilloma at the Tygerberg Hospital (TBH) between January 2013 and December 2015.Methods. This was a retrospective analysis conducted at TBH. Patients were followed up between 6 and 29 months following diagnosis to analyse outcomes. Results. Fifty-nine patients presented for surgery. The mean (SD) age was 44.5 (8.8) years. Thirty-six (61.0%) were male and 13 (22.0%) were HIV-positive. A previous history of pulmonary TB was identified in 83.1% of the patients. One or both upper lobes were involved in 58 patients (98.3%) and haemoptysis was the most frequent symptom, occurring in 56 patients (94.9%). Nine patients (15.3%) were considered unfit for surgery. As of June 2016, 23 (46.0%) of the remaining 50 patients had undergone surgery and 3 (6.0%) had died before surgery was performed. The median time from multidisciplinary discussion to surgery was 190 days (interquartile range 134 -351). Twenty patients (87.0%) underwent lobectomy and 3 (13.0%) had pneumonectomy. There was no postoperative mortality. One patient developed bleeding, persistent air leak and aspiration pneumonia postoperatively. Three patients were hospitalised for >7 days postoperatively. Following surgery, only two patients reported ongoing respiratory symptoms by day 90. Conclusion. Less than half of the patients accepted for lung resection at TBH underwent surgery. Waiting times were long (>1 year in 25%) and were associated with mortality. Barriers to prompt surgery are complex, but should be addressed urgently.

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Section: Discussionsupporting

confidence: 86%

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confidence: 99%

Outcomes of resectable pulmonary aspergilloma and the performance gap in a high tuberculosis prevalence setting: A retrospective study

et al. 2017

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“…With better surgical techniques, treatment outcomes have improved in recent years [130]. Procedures include bullectomy, segmentectomy, sublobar resection, wedge resection, lobectomy, pleurectomy, pneumonectomy.…”

Section: Follow-upmentioning

confidence: 99%

Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

Denning¹,

Cadranel²,

et al. 2015

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Chronic pulmonary aspergillosis (CPA) is an uncommon and problematic pulmonary disease, complicating many other respiratory disorders, thought to affect ∼240 000 people in Europe. The most common form of CPA is chronic cavitary pulmonary aspergillosis (CCPA), which untreated may progress to chronic fibrosing pulmonary aspergillosis. Less common manifestations include: Aspergillus nodule and single aspergilloma. All these entities are found in non-immunocompromised patients with prior or current lung disease. Subacute invasive pulmonary aspergillosis (formerly called chronic necrotising pulmonary aspergillosis) is a more rapidly progressive infection (<3 months) usually found in moderately immunocompromised patients, which should be managed as invasive aspergillosis. Few clinical guidelines have been previously proposed for either diagnosis or management of CPA. A group of experts convened to develop clinical, radiological and microbiological guidelines. The diagnosis of CPA requires a combination of characteristics: one or more cavities with or without a fungal ball present or nodules on thoracic imaging, direct evidence of Aspergillus infection (microscopy or culture from biopsy) or an immunological response to Aspergillus spp. and exclusion of alternative diagnoses, all present for at least 3 months. Aspergillus antibody (precipitins) is elevated in over 90% of patients. Surgical excision of simple aspergilloma is recommended, if technically possible, and preferably via video-assisted thoracic surgery technique. Long-term oral antifungal therapy is recommended for CCPA to improve overall health status and respiratory symptoms, arrest haemoptysis and prevent progression. Careful monitoring of azole serum concentrations, drug interactions and possible toxicities is recommended. Haemoptysis may be controlled with tranexamic acid and bronchial artery embolisation, rarely surgical resection, and may be a sign of therapeutic failure and/or antifungal resistance. Patients with single Aspergillus nodules only need antifungal therapy if not fully resected, but if multiple they may benefit from antifungal treatment, and require careful follow-up. @ERSpublications ERS and ESCMID guideline for the management of chronic pulmonary aspergillosis released

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“…В последние годы по мере улучшения хирурги ческой техники исходы лечения улучшаются [130]. Сегодня возможны буллэктомия, сегментэктомия, сублобарная резекция, краевая резекция, лобэкто мия, плеврэктомия, пульмонэктомия.…”

Section: клинические рекомендацииunclassified

Diagnosis and treatment of chronic pulmonary aspergillosis: clinical guidelines of European Society for Clinical Microbiology and Infectious Diseases and European Respiratory Society

Denning¹,

Cadranel²,

Ader³

et al. 2017

Pulʹmonologiâ (Mosk.)

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Chronic pulmonary aspergillosis (CPA) is infrequent respiratory disease which is difficult for diagnosis and can complicate other respiratory diseases and conditions. Currently, there are about 240,000 CPA patients in Europe. The most prevalent variant of CPA is chronic cavitary pulmonary aspergillosis (CCPA) which could progress to chronic fibrosing pulmonary aspergillosis (CFPA) when is untreated. Aspergillus nodules and single aspergilloma are less frequent clinical variants of this disease. All clinical variants of aspergillosis could be found in nonimmunocompromised patients with different underlying pulmonary disorders. Subacute invasive pulmonary aspergillosis, which was referred to as chronic necrotising pulmonary aspergillosis, is the most rapidly progressive clinical variant of the infection (< 3 months); it is typically diagnosed in moderately immunocompromised patients and should be treated as invasive aspergillosis. Diagnosis and management of CPA patients were previously described in sporadic guidelines. Due to this, expert group have been convened to develop clinical, radiological and microbiological guidelines. Diagnosis of CPA requires a combination of the following criteria existing for 3 months or more: one or more cavities in the lungs with or without fungal mass inside or nodules found on radiological examination; direct evidence of Aspergillus infection (using microscopic examination or biopsy culturing) or immunological response to Aspergillus spp. and exclusion of alternative diseases. Antibodies against Aspergillus spp. (precipitins) are increased in > 90% of patients. Aspergilloma should be resected if technically possible; videoassisted thoracic surgery is preferable. Chronic cavitary pulmonary aspergillosis requires longterm oral antifungal therapy to improve the patients' health and respiratory symptoms, to arrest haemoptysis and prevent the disease progression. Azole serum concentration and drug interaction should be thoroughly monitored to avoid toxic effects. Haemoptysis could be arrested using therapy with tranexamic acid or bronchial artery embolization; surgical resection of the lung is rarely required. Haemoptysis could indicate therapeutic failure and / or resistance to antifungals. Patients with a single Aspergillus nodule need antifungal therapy only if surgical resection is impossible. Antifungal therapy could be beneficial in patients with multiple Aspergillusis nodules; these patients need careful followup.

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Surgery for aspergilloma: time trend towards improved results?

Cited by 48 publications

References 15 publications

Outcomes of resectable pulmonary aspergilloma and the performance gap in a high tuberculosis prevalence setting: A retrospective study

Outcomes of resectable pulmonary aspergilloma and the performance gap in a high tuberculosis prevalence setting: A retrospective study

Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

Diagnosis and treatment of chronic pulmonary aspergillosis: clinical guidelines of European Society for Clinical Microbiology and Infectious Diseases and European Respiratory Society

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