Article Abstract

Special issue on inflammatory thoracic disease: surgical experience of pulmonary aspergilloma

Authors: Sukki Cho


Background: Video-assisted thoracic surgery (VATS) has been attempted for the removal of pulmonary aspergilloma (PA). The purpose of this study was to provide a review of the surgical strategies and methods used to resect PA in our institution.
Methods: Between 2003 and 2018, 76 patients were surgically treated for PA at Seoul National University Bundang Hospital (SNUBH). Surgical indications were based on symptoms, including recurrent hemoptysis failed by bronchial artery embolization (BAE), persistent cough, and intractable sputum.
Results: A total of 76 patients, consisting of 35 males and 41 females, were included. The median age was 56 (range, 17–79) years. Hemoptysis was seen in 58 (76%) patients, persistent cough with blood tinged sputum in 8 (11%) patients, and persistent sputum with cough in 10 (13%) patients. Simple PA was seen in 59 (78%) patients and complex PA in 17 (22%) patients. Regarding surgery, open thoracotomy was performed in 38 (50%) patients and VATS in 38 (50%) patients. All complex PA patients were performed on by open thoracotomy or conversion. Bronchial stump coverage was performed only in 20 (26%) patients with viable tissue, such as intercostal muscle or pericardial fat. Intraoperative bleeding was developed in 6 (8%) patients who needed to convert to open thoracotomy. Concerning the extent of resection, lobectomy was done in 44 patients, bilobectomy in 1 patient, and pneumonectomy in 4 patients. Sublobar resection, consisting of 13 wedge resections and 14 of segmentectomies, was also performed in 27 patients. Major complications developed in 13 (17%) patients. Postoperative empyema was observed in 4 patients. The mean hospital stay was 8.2 (range, 2–34) days, and 3 patients were readmitted.
Conclusions: Surgery is only an effective treatment method for symptomatic patients with PA. The operative risk is low and VATS may be possible in simple PA. However, in patients who have recurrent hemoptysis and complex PA, the operative risk may be high with increased risk of postoperative complications; such patients should avoid extensive surgical intervention.