Short papers Surgical treatment for pulmonary aspergilloma: a 28 year experience

mortality following surgery of the collected series of Kilman et al was about 7%. In larger Background – Pulmonary aspergilloma has been treated surgically for many years single series reported by Jewkes et al and Daly et al the mortality following surgery was as but the mortality rates of larger surgical series, varying from 7% to 23%, is not high as 14% (seven of 49) and 23% (12 of 53), respectively. Even in the more recent study considered acceptable by today’s standards. The authors report their experience reported by Massard et al in 1992 it was around 9%. The major cause of surgical mortality rein the surgical treatment of pulmonary aspergilloma and present a review of the mains obscure and the most common type of morbidity is not well known. We present a literature. Methods – Sixty seven patients who underreview of the surgical mortality and morbidity reported in the literature and present our exwent thoracotomy for pulmonary aspergilloma from 1968 to 1995 were studied perience with the surgical treatment of pulmonary aspergilloma at the National Taiwan retrospectively by reviewing their medical records. University Hospital over a period of 28 years. Results – The most common clinical presentation of pulmonary aspergilloma was haemoptysis which occurred in 61 patients Methods (91.0%). Tuberculosis was the most comBetween 1968 and 1995, 72 patients were mon pre-existing disease, occurring in 54 identified pathologically at the National Taiwan patients (80.6%). The plain chest radioUniversity Hospital as having pulmonary aspergraph showed the typical “air-crescent” gillomas. Treatment with transarterial emsign in 36 patients (53.7%). Systemic antibolisation was tried unsuccessfully in nine fungal therapy neither palliated the patients and all eventually resorted to surgery. clinical symptoms nor eradicated the Antifungal chemotherapy with amphotericin B aspergilloma, and transarterial em(1.0–1.5 mg/kg/day), alone or combined with bolisation was also unsuccessful. Surgery flucytocine (100–150 mg/kg/day), was given to offered the only chance of cure for both 19 patients, five of whom are excluded from unilateral and bilateral disease. Prothe study because they did not undergo surgery. cedures varied from segmentectomy to Thus, a total of 67 cases (46 men) of mean pneumonectomy with most (61.4%) age 40.2 years (range 20–73) were enrolled into undergoing lobectomy. There was one the study. The aspergillomas were classified death following surgery from pneumonia according to the system of Belcher and Plumand 15 postoperative complications ocmer. Simple aspergillomas had thin-walled curred in 12 patients – empyema (7), mascysts with little or no surrounding parenchymal sive bleeding (3), bronchopleural fistula lung disease and complex ones had thick-walled Department of (2), wound infection (2), and Horner’s syncavities with substantial surrounding parSurgery drome (1). Postoperatively, most of the J-C Chen enchymal lung disease or associated infiltrates. S-P Luh patients were symptom-free. The indications for surgery included sympJ-M Lee Conclusions – With appropriate pretomatic “air-crescent” lesions, indeterminate Y-C Lee operative evaluation and judicious surlung mass, destruction of the lung or a lung Department of gical technique, surgery is the preferred lesion with clinical haemoptysis. The extent of Pathology treatment for pulmonary aspergilloma, lung resection was determined by the amount Y-L Chang both for eradicating the tumour and for National Taiwan of involvement by the aspergilloma and the University Hospital, curing the underlying disease. degree of lung function. In difficult cases it was No. 7 Chung-Shan S (Thorax 1997;52:810–813) sometimes necessary to cut two ribs (fourth Road, 100-02 Taipei, Taiwan and fifth or fifth and sixth) to get a better