Clinical profile and surgical outcome for pulmonary aspergilloma: a single center experience.
BACKGROUND
This retrospective study was designed to study the clinical profile, indications, postoperative complications and long-term outcome of pulmonary aspergilloma operated in our institute.


METHODS
From 1985 to 2003, 60 patients underwent surgery for pulmonary aspergilloma at Sree Chitra Tirunal Institute for Medical Sciences and Technology.


RESULTS
The group consisted of 36 male patients and 24 female patients with a mean age of 42.7 +/- 11.8 years. The most common indication for surgery was hemoptysis (93.3%). The common underlying lung diseases were tuberculosis (45%), bronchiectasis (28.3%), and lung abscess (11.6%). Fourteen patients (23%) had simple aspergilloma (SA) and 46 (77%) had complex aspergilloma (CA). The procedures performed were lobectomy (n = 55), pneumonectomy (n = 2), segmental resection (n = 2), and cavernoplasty (n = 2). One patient underwent bilateral lobectomy at 14 months interval. The operative mortality was 4.3% and 0% in CA and SA, respectively (p = 1.0). Major complications occurred in 26.1% patients of CA, whereas none occurred in SA (p = 0.052). The complications included bleeding (n = 2), prolonged air leak (n = 4), empyema (n = 4), repeated pneumothorax (n = 1), and wound dehiscence (n = 1). Three patients needed thoracoplasty. The mean follow-up period was 40 +/- 24 months. The actuarial survival at 10 years was 78% and 92% for CA and SA, respectively. There was no recurrence of disease or hemoptysis.


CONCLUSIONS
Surgical resection of pulmonary aspergilloma prevents recurrence of hemoptysis. Complex aspergilloma resection was associated with low mortality but significant morbidity, whereas SA had no associated early mortality and morbidity. Long-term outcome is good for SA and satisfactory for CA.
Akbari
Jayesh Gopal
JG
Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
Varma
Praveen Kerala
PK
Neema
Praveen Kumar
PK
Menon
Madathipatt Unnikrishnan
MU
Neelakandhan
Kurur Sankaran
KS
D000328:Adult; D001228:Aspergillosis / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006469:Hemoptysis / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007194:India / Q000453:epidemiology; D008137:Longitudinal Studies; D008168:Lung / Q000000981:diagnostic imaging; D008171:Lung Diseases / Q000453:epidemiology; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011013:Pneumonectomy / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011859:Radiography; D012189:Retrospective Studies; D013147:Spirometry; D016019:Survival Analysis