Pulmonary Aspergilloma Treated by Limited Thoracoplasty with Simultaneous Cavernostomy and Muscle Transposition Flap

Igai, Hitoshi; Kamiyoshihara, Mitsuhiro; Nagashima, Toshiteru; Ohtaki, Yoichi

doi:10.5761/atcs.cr.11.01757

Cited by 12 publications

(10 citation statements)

References 7 publications

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“…According to United Nations data (April12,2020), the median age in Ethiopian population is 19.5 years. A similar finding of higher proportion of the younger patients with PA was also noticed in this study (17)(18)(19).…”

Section: Discussionsupporting

confidence: 90%

Surgical Outcome of Chronic Pulmonary Aspergilloma: An Experience from Two Tertiary Referral Hospitals in Addis Ababa, Ethiopia

Alemu

2020

Ethiop J Health Sci

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Background: Surgical management of pulmonary aspergillosis is challenging and controversial. This study is designed to assess the clinical profile, indications and surgical outcome of Pulmonary aspergilloma.Methods: A retrospective cross-sectional analysis of 72 patients who underwent pulmonary resection for pulmonary aspergilloma over the period from November, 2014, to November, 2019 was done. Data on demographic, clinical and surgical out come were retrieved. Analysis was done using SPSS version 23. Chi-square test was used to assess for significance of the association between variables and surgical outcome.Results: There were 46(63.9%) males and 26(36.1%) female patients with a mean age of 35.2+/-11.6 years (Range 16– 65 years). All patients were previously treated for tuberculosis. Cough, hemoptysis, and shortness of breath were the main symptoms identified. A ball of fungus together with the surrounding lung was removed. Accordingly, 32(44,4%) lobectomies, 12(16.7%) pneumonectomy, 7(9.7%) Bi-lobectomy,and 21(29.2%) cavernostomy were done. Intraoperative and Postoperative complications were seen in 8(11.1%) and 21(29.1%) patients respectively. Major morbidity encounters included massive intraoperative blood loss, prolonged air leak, empyema, air space, bronchopleural fistula, and wound infection. The hospital mortality was 3(4.2%) and the average hospital stay was 14.8days. Postoperative complications were evaluated for the difference in socio-demographic characteristics and other variables and a statistically significant difference was detected only for the location of aspergilloma, site of the lung involved and type of surgery done. (P-value <0.05.)Conclusion: Pulmonary resection done for pulmonary aspergilloma showed favorable outcomes when done with good patient selection, meticulous surgical techniques, and good postoperative management. However, its long term outcome and role of antifungal treatment as adjunctive therapy for surgical resection need further investigation.

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Section: Discussionsupporting

confidence: 90%

Surgical Outcome of Chronic Pulmonary Aspergilloma: An Experience from Two Tertiary Referral Hospitals in Addis Ababa, Ethiopia

Alemu

2020

Ethiop J Health Sci

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“…Unexpected peri-operative issues may necessitate conversion to thoracotomy (bleeding, dense fibrous adhesions, fused interlobar fissure, or hilar lymphadenopathy) [132]. Some patients with extensive disease may require thoracoplasty with simultaneous cavernostomy and muscle transposition flap (SoR C and QoE III) [133,134]. Antifungal therapy can be administered to prevent Aspergillus empyema or to avoid recurrence of disease when complete resection is not possible [125], but there is no evidence to support this role of adjuvant triazole antifungal therapy following definitive surgical removal of a single aspergilloma [139,140], although a more nuanced approach is warranted in our view [125].…”

Section: Follow-upmentioning

confidence: 99%

Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

Denning¹,

Cadranel²,

et al. 2015

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Chronic pulmonary aspergillosis (CPA) is an uncommon and problematic pulmonary disease, complicating many other respiratory disorders, thought to affect ∼240 000 people in Europe. The most common form of CPA is chronic cavitary pulmonary aspergillosis (CCPA), which untreated may progress to chronic fibrosing pulmonary aspergillosis. Less common manifestations include: Aspergillus nodule and single aspergilloma. All these entities are found in non-immunocompromised patients with prior or current lung disease. Subacute invasive pulmonary aspergillosis (formerly called chronic necrotising pulmonary aspergillosis) is a more rapidly progressive infection (<3 months) usually found in moderately immunocompromised patients, which should be managed as invasive aspergillosis. Few clinical guidelines have been previously proposed for either diagnosis or management of CPA. A group of experts convened to develop clinical, radiological and microbiological guidelines. The diagnosis of CPA requires a combination of characteristics: one or more cavities with or without a fungal ball present or nodules on thoracic imaging, direct evidence of Aspergillus infection (microscopy or culture from biopsy) or an immunological response to Aspergillus spp. and exclusion of alternative diagnoses, all present for at least 3 months. Aspergillus antibody (precipitins) is elevated in over 90% of patients. Surgical excision of simple aspergilloma is recommended, if technically possible, and preferably via video-assisted thoracic surgery technique. Long-term oral antifungal therapy is recommended for CCPA to improve overall health status and respiratory symptoms, arrest haemoptysis and prevent progression. Careful monitoring of azole serum concentrations, drug interactions and possible toxicities is recommended. Haemoptysis may be controlled with tranexamic acid and bronchial artery embolisation, rarely surgical resection, and may be a sign of therapeutic failure and/or antifungal resistance. Patients with single Aspergillus nodules only need antifungal therapy if not fully resected, but if multiple they may benefit from antifungal treatment, and require careful follow-up. @ERSpublications ERS and ESCMID guideline for the management of chronic pulmonary aspergillosis released

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“…This is the difference between our study and other studies using myoplasty. In thoracoplasty, over the years many tissues and materials were tried as a filler, cavernostomy had been performed and showed useful such as single-stage using muscle transposition flap [15,42], cavernostomy with limited thoracoplasty [15] and simplified cavernostomy involving Alexis Wound Protector [43]. Flap transposition has been approved as component of a multimodal treatment [44] with most used flaps were the latissimus dorsi and the serratus [45].…”

Section: Discussionmentioning

confidence: 99%

Hemoptysis from Complex Pulmonary Aspergilloma Treated by Cavernostomy and Thoracoplasty

Giang¹,

Dũng²,

Hien³

et al. 2019

Preprint

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Background In high-risk patients with complex pulmonary aspergilloma but unable for lung resection, cavernostomy and thoracoplasty could be performed. This study aimed to evaluate this surgery compared two material used (table tennis ball and tissue expander) as a filler. Methods: The prospective study evaluated 63 in high-risk patients who had hemoptysis due to complex pulmonary aspergilloma that submitted to cavernostomy and thoracoplasty surgery from November 2011 to September 2018. Patients were allocated to the table tennis ball group (46 patients) and tissue expander group (17 patients). We evaluated at the time of before operation, six months and 24 months after operation. Results The most common comorbidity diseases were tuberculosis in two groups. Upper lobe occupied almost location. Hemoptysis symptoms plunged from time to time. Statistically significant Karnofsky score was observed in both groups. BMI showed slightly increasing but not statistically significant. Postoperative pulmonary functions (FVC and FEV1) have remained in both groups at all time points. The remarkable results were no death in the postoperative period, and long-term complication of surgery was low. There was no statistical significance between two groups in operative time, blood loss during operation, ICU length-stay time. Four patients died because of co-morbidity in 24 months follow-up. Conclusion: Cavernostomy and thoracoplasty was safe and effective surgery for the treatment of high-risk patients with complex pulmonary aspergilloma. There was no mortality related to surgery. The postoperative complications and long-term complication were low. The was no inferiority when compared table tennis ball group and tissue expander group. Keyword: Complex Pulmonary Aspergilloma (CPA), Hemoptysis, Cavernostomy, Thoracoplasty, Table Tennis Balls, Tissue expander,

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Pulmonary Aspergilloma Treated by Limited Thoracoplasty with Simultaneous Cavernostomy and Muscle Transposition Flap

Cited by 12 publications

References 7 publications

Surgical Outcome of Chronic Pulmonary Aspergilloma: An Experience from Two Tertiary Referral Hospitals in Addis Ababa, Ethiopia

Surgical Outcome of Chronic Pulmonary Aspergilloma: An Experience from Two Tertiary Referral Hospitals in Addis Ababa, Ethiopia

Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

Hemoptysis from Complex Pulmonary Aspergilloma Treated by Cavernostomy and Thoracoplasty

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