Good long-term outcomes after surgical treatment of simple and complex pulmonary aspergilloma

BACKGROUND: The long-term outcomes of pulmonary aspergilloma have been known to depend on the underlying lung disease. We analyzed the surgical long-term outcomes for both simple and complex aspergilloma. METHODS: From 1981 to 1999, 90 surgical procedures were performed on 88 patients with pulmonary aspergilloma. The patients included 44 men and 44 women with a median age of 41 years (range, 12 to 69 years). The underlying lung diseases in the 72 complex aspergilloma cases were 57 tuberculosis (65%), 14 bronchiectases (16%), and 1 emphysema (1.1%). Sixteen (18%) had no underlying lung disease. The procedures performed were 52 lobectomies, 33 segmentectomies or wedge resections, 3 pneumonectomies, and 2 cavernostomies. RESULTS: One case of operative mortality (1.1%) occurred in complex aspergilloma. Among the other patients, 24 complications developed (27%): 11 prolonged air leaks (longer than 7 days), 7 persistent spaces, 3 postoperative bleedings, 2 empyemas, 2 pneumonias, and 1 wound infection. Risk factor analysis revealed old age and complex aspergilloma as significant risk factors for postoperative complication. One simple and 13 complex aspergilloma patients died during the follow-up period. Only 4 deaths were caused by pulmonary problems. The 10-year actuarial survival rates of simple and complex aspergilloma were 80.0% and 79.6%, respectively. There was no difference between the long-term survival of simple and complex aspergilloma. CONCLUSIONS: Although the postoperative morbidity rate was higher in complex aspergilloma, surgical treatment for both simple and complex aspergilloma could achieve satisfactory long-term outcomes in selected groups of patients.