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.