Surgical Outcome of Chronic Pulmonary Aspergilloma: An Experience from Two Tertiary Referral Hospitals in Addis Ababa, Ethiopia

Abstract

Background: Surgical management of pulmonary aspergillosis is challenging and controversial. This study is designed to assess the clinical profile, indications and surgical outcome of Pulmonary aspergilloma.Methods: A retrospective cross-sectional analysis of 72 patients who underwent pulmonary resection for pulmonary aspergilloma over the period from November, 2014, to November, 2019 was done. Data on demographic, clinical and surgical out come were retrieved. Analysis was done using SPSS version 23. Chi-square test was used to assess for significance of the association between variables and surgical outcome.Results: There were 46(63.9%) males and 26(36.1%) female patients with a mean age of 35.2+/-11.6 years (Range 16– 65 years). All patients were previously treated for tuberculosis. Cough, hemoptysis, and shortness of breath were the main symptoms identified. A ball of fungus together with the surrounding lung was removed. Accordingly, 32(44,4%) lobectomies, 12(16.7%) pneumonectomy, 7(9.7%) Bi-lobectomy,and 21(29.2%) cavernostomy were done. Intraoperative and Postoperative complications were seen in 8(11.1%) and 21(29.1%) patients respectively. Major morbidity encounters included massive intraoperative blood loss, prolonged air leak, empyema, air space, bronchopleural fistula, and wound infection. The hospital mortality was 3(4.2%) and the average hospital stay was 14.8days. Postoperative complications were evaluated for the difference in socio-demographic characteristics and other variables and a statistically significant difference was detected only for the location of aspergilloma, site of the lung involved and type of surgery done. (P-value <0.05.)Conclusion: Pulmonary resection done for pulmonary aspergilloma showed favorable outcomes when done with good patient selection, meticulous surgical techniques, and good postoperative management. However, its long term outcome and role of antifungal treatment as adjunctive therapy for surgical resection need further investigation.

Surgical management of chronic pulmonary aspergillosis in Africa: A systematic review of 891 cases

“…38 Since then, several cases series and large studies have been published on the surgical management of CPA. 5,9,10,[39][40][41] In this study, reviewing Data from a global centre of excellence for the management of CPA suggest that about 5% of patients with CPA, especially those with simple aspergilloma require a surgical intervention for definitive management of CPA, obviating the need for long-term antifungal treatment. 42 About half of patients who fail antifungal therapy may also require surgical interventions.…”

“…5,7 In the past few decades, several case reports and case series on surgical management of CPA in Africa have been published. [8][9][10][11][12][13][14] Given the limited access to and availability of essential antifungal agents for the management of CPA in Africa, it is important that outcomes of surgically managed CPA patients are evaluated to inform clinicians on the surgical management of CPA and outcomes in Africa. In this study, therefore, we sought to systematically review and summarise outcomes of all published cases of CPA managed surgically in Africa.…”