When conservative surgery is sufficient in treatment of pulmonary aspergilloma ?

Abstract

Method: Pulmonary Aspergilloma is caused by the development of a mycelial mass of the genus Aspergillus, in a preexisting cavity, most often tuberculous. Surgery remains the basic treatment, most commonly by major resection to prevent recurrence.

Method: This a retrospective study spread over a period of 25 years extending from January 1994 to September 2019. Our aim was to analyze characteristics of pulmonary aspergillomas which had conservative surgery.

Method: During the study period, 19 patients had conservative surgical treatment for pulmonary aspergilloma in our institution. In the same period 87 patients had undergone anatomical resection.

There were 13 male and 6 female with a mean age of 44 years. CT scan was performed for all patients. Lesions were well limited, located on right lung in 11 cases.

Posterolateral thoracotomy was the main approach used in 15 cases. Video-assissted thoracic surgery was performed in four cases. The surgical procedure was atypical resection in 11 cases, cystectomy in four cases and flattening in four cases.

Follow-up was uneventful for 16 patients. Two patients had prolonged air leak and one patient had postoperative pulmonary infection. One case of aspergilloma recurrence had been recorded. We compared postoperative outcomes between patients who had conservative surgery and those who had major resection. There was no significant difference (p= 0.07).

Conclusion: Surgery is the treatment of choice in aspergilloma. Conservative surgery has its particular indications with good long term results.