Surgical treatment of pulmonary aspergillosis: A single center experience

Abstract

Background:Aspergillus fumigatus is a saprophytic fungus which colonizes in the cavitary lesions in the lungs. In our part of the world, where tuberculosis is endemic, the healed tubercular cavities form a good nidus for this fungus. The fungus forms a fungal ball or aspergilloma within the cavity, which erodes the walls of the cavity and causes hemoptysis by erosion of the bronchial vessels. Hemoptysis is the main symptom. Antifungal agents are not useful against the fungal ball. Surgery in the form of lobectomy is the primary treatment. Surgery for aspergilloma is known to be risky because of intra-pleural adhesions, obliteration of the interlobar fissures, massive hemorrhage during dissection and poor pulmonary reserve of the patient due to the underlying disease.Materials and Methods:Clinical presentation, radiological investigations, operative techniques, postoperative outcome, and follow-up of 24 cases of pulmonary aspergilloma treated surgically were studied prospectively between August 2010 and July 2013 at IPGMER and SSKM Hospital, Kolkata.Results:There were 15 male (62.5%) and 9 female (37.5%) patients. Mean age of the study population was 34.54 years. All the patients had complex aspergilloma. Tuberculosis was the underlying disease in 22 patients (91%). Hemoptysis was the main symptom in 79.16% cases. Chest X-ray was the first investigation, which gave a clue to the diagnosis. Computed tomography scan was diagnostic in all cases. Lobectomy was done in 16 patients (66.67%). There was one mortality and the overall complication was 33.33%. The average follow-up period was 21.65 months, during which there was no mortality and no recurrence of hemoptysis in these patients.Conclusions:Though surgery for aspergilloma is considered to be risky, excision of the cavity along with the involved lobe can be done with acceptable morbidity and mortality to provide the patient complete cure and symptom-free survival.

Video-assisted thoracoscopic surgery for pulmonary aspergilloma

“…also from India. [ 19 20 ] One, therefore, needs to weigh the overall risk-benefit ratio carefully and select cases accordingly for consistently better outcomes which brings us to reviewing the indications of surgery. The risk of developing complications pushes the balance in favor of an invasive approach.…”

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

“…However, studies showed that radical resection of the affected areas had effectively improved patient outcomes. Because of this argument, many case series studies advocate a standard thoracotomy and lobectomy to be the preferred surgical procedures (7)(8)(9)(10)(11)(18)(19)(20)(21)(22)(23). In this series, lobectomy was done for 44.4% of patients.…”

Invasive Diagnostics and Surgical Treatment of Pulmonary Aspergillosis

“…Через невизначеність в методах і термінах лікування пацієнтів з аспергільозом легень, базуючись на закордонних рекомендаціях та власних дослідженнях, в статті представлено досвід хірургічного лікування даного захворювання в нашій клініці. [11].…”

“…Це призводить до утворення залишкової плевральної порожнини, перерозтягнення легені з формуванням бронхо-плевральної нориці та інфікуванням плевральної порожнини. Тому існує дві думки з цього приводу: інтраопераційне вирішення та одномоментне виконання торакопластики та виконання торакопластики через 2-3 тижні у випадку наявності залишкової плевральної порожнини [2,5,10,11]. В нашій клініці, за необхідності, ми намагаємося виконувати одномоментну інтраплевральну торакопластику.…”