TABLE 11

Indications for and types of surgery for chronic pulmonary aspergillosis

PopulationIntentionInterventionSoRQoERef.Comment
Single/simple aspergillomaCure and prevention of life-threatening haemoptysisLobectomy or any other segmental resectionAII[9, 21, 124– 131]Risk/benefit assessment required. Patients should be seen in centres with experience of aspergillosis surgery.
VATSBII[129, 132]May require conversion to thoracotomy.
CCPA refractory to medical  management (including  multi-azole resistance) with  antifungal treatment and/or  life-threatening haemoptysisImproved control of disease, possibly cureCareful risk assessment, followed by lobectomy or pneumectomy Thoracoplasty with simultaneous cavernostomy and muscle transposition flapA


C/D
II


III
[125, 127]


[133, 134]
Prior embolisation as a temporising procedure.

Highly experienced surgical team required.
  • SoR: strength of recommendation; QoE: quality of evidence; CCPA: chronic cavitary pulmonary aspergillosis; VATS: video-assisted thoracic surgery.