title: Surgical outcome of pulmonary resection in chronic necrotizing pulmonary aspergillosis.
abstract: BACKGROUND
  Surgical treatment of chronic necrotizing pulmonary aspergillosis is hazardous and controversial.
  
  
  METHODS
  Ten patients (8 men, 2 women; mean age, 50 years) with chronic necrotizing pulmonary aspergillosis underwent pulmonary resection between 1989 and 2000. Single segmentectomy or lobectomy, pneumonectomy, or bilobectomy and multisegmentectomy were performed. Clinicopathologic features of these patients were reviewed to clarify the role of surgical intervention for chronic necrotizing pulmonary aspergillosis.
  
  
  RESULTS
  The mean time from the onset of clinical symptoms to operation was 5.3 years. Surgical intervention was undertaken because of prolonged illness in 4 patients and hemoptysis in 6 patients. All patients survived. Three major complications (1 late empyema, 2 bronchopleural fistulas) occurred in the large dead space in the right pleural cavity. All survivors were free of aspergillosis at a mean follow-up time of 4.8 years, and only 1 patient required antifungal drugs for relapse during the follow-up period.
  
  
  CONCLUSIONS
  Aggressive pulmonary resection in chronic necrotizing pulmonary aspergillosis should be considered when patients have prolonged illness or frequent hemoptysis. Empyema and bronchopleural fistula are the main complications. Concomitant thoracoplasty or intrathoracic transposition of the chest wall musculature is recommended in cases involving a large residual pleural cavity on the right side.
authors.affiliation: Department of Thoracic Surgery, Jichi Medical School, Kawachi-gun, Tochigi, Japan. tcvshun@jichi.ac.jp
authors.forename: S
authors.initials: S
authors.lastname: Endo
authors.forename: Y
authors.initials: Y
authors.lastname: Sohara
authors.forename: F
authors.initials: F
authors.lastname: Murayama
authors.forename: T
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: T
authors.initials: T
authors.lastname: Hasegawa
authors.forename: K
authors.initials: K
authors.lastname: Tezuka
authors.forename: S
authors.initials: S
authors.lastname: Yamamoto
mesh_terms: D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000000981:diagnostic imaging / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011013:Pneumonectomy; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome