title: Surgical therapy of pulmonary aspergillomas: a 30-year North American experience.
abstract: BACKGROUND
  Pulmonary aspergilloma is resected to control life-threatening complications such as massive hemoptysis. The role of prophylactic resection in asymptomatic patients is unclear.
  
  
  METHODS
  A retrospective review was conducted of 60 patients treated at a tertiary center from 1980 to 2010.
  
  
  RESULTS
  The mean age in 34 (56.7%) men and 26 (43.3%) women was 51 years. Immunosuppression, most commonly from chronic steroid use, was present in 17 (28.3%) patients, and preexisting lung disease was present in 47 (78.3%) patients. Hemoptysis occurred in 33 (55%) patients, whereas 9 (15.0%) patients were asymptomatic. Aspergilloma was simple in 13 (21.7%) patients and complex in 47 (78.3%) patients. Surgical approach was by thoracotomy (n=51 [85.0%]), video-assisted thoracoscopic surgery (n=7 [11.7%]), or a cavernostomy (n=2 [3.3%]). Sublobar resections (n=28 [46.7%]) were most common, followed by lobectomy (n=27 [45%]) and pneumonectomy (n=3 [5%]). Postoperative morbidity occurred in 18 (30%) patients, with prolonged air leak the most frequent complication (n=9 [15%]). Two (3.3%) patients experienced empyema, and 4 (6.7%) patients had bronchopleural fistulas (BPFs). Two patients died within 30 days (3.3%). During a mean follow-up of 54.1±62.2 months, 3 patients had recurrent aspergillomas (5.0%). Actuarial 10-year survival was 62.5% for simple and 68.5% for complex aspergillomas (p=0.858). Comorbid conditions (human immunodeficiency virus [HIV] positivity, malignancy) and male sex were associated with lower survival.
  
  
  CONCLUSIONS
  Selective surgical treatment favoring lesser pulmonary resection results in fungal eradication and control in most patients. Overall survival is similar after surgical management of simple and complex aspergillomas.
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: amuniappan@partners.org.
authors.forename: Ashok
authors.initials: A
authors.lastname: Muniappan
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Luis F
authors.initials: LF
authors.lastname: Tapias
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Parag
authors.initials: P
authors.lastname: Butala
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: John C
authors.initials: JC
authors.lastname: Wain
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Wright
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Dean M
authors.initials: DM
authors.lastname: Donahue
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Henning A
authors.initials: HA
authors.lastname: Gaissert
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Lanuti
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Mathisen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055732:Pulmonary Aspergillosis / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: 11