[Surgical treatment of pulmonary aspergilloma. 278 cases].

Study Objectives: The purpose of this study was to report the results of surgical treatment of pulmonary aspergilloma in 278 consecutive patients in a hospital using surgical treatment systematically when possible to avoid potentially fatal bleeding.

Methods: Diagnosis required morphological assessment as well as testing of sputum and blood samples. Preoperative studies also included pulmonary function tests for all patients. Surgical intervention was systematic, for treatment or diagnostic purposes. The incision of choice was a standard posterolateral thoracotomy via the 5th intercostal space. Mycological examination of the parenchymatous cavity confirmed the diagnosis. Immediate postoperative surveillance depended on clinical, radiologic, and laboratory findings as well as pleural drainage. Postoperative clinical and radiographic follow-up took place during the first month, the third month and then every 6 months.

Results: Between 1982 and 2004, our thoracic surgery department saw 320 cases of pulmonary aspergilloma. In all, 278 patients (161 men and 117 women) underwent pulmonary resection. The mean age was 32 years (range: 16-70 years). The principal underlying disease was tuberculosis (73%), and the most common symptom hemoptysis (83%). Treatment was exclusively surgical in all patients, and there were 279 resections because one patient had staged bilateral segmentectomy. Resections included 130 lobectomies, 51 segmentectomies, 45 pneumonectomies, 33 lobectomies with segmentectomy, 17 bilobectomies and 3 thoracoplasties. There were 16 postoperative deaths (5.7%), 14 of them in patients who had undergone pneumonectomy. Postoperative complications included empyema (12.5%), incomplete reexpansion (9.3%), postoperative bleeding (5%), respiratory infections (4.6%), respiratory failure (4%), bronchial fistula (2.5%) and wound infections (2%). 12 patients had further surgery: 3 for hemothorax, 2 for empyema and 4 for secondary thoracoplasty. The postoperative course was uneventful for 54.1% of cases.

Conclusion: Surgery for pulmonary aspergilloma is difficult and dangerous. It nonetheless remains the treatment of choice of this opportunistic pulmonary mycosis, despite the high risk of postoperative morbidity and mortality.