Surgical treatment for pulmonary aspergilloma: a 35-year experience in the Chinese population

Chen, Qiankun; Jiang, Gening; Ding, Jian

doi:10.1093/icvts/ivs130

Cited by 65 publications

(83 citation statements)

References 15 publications

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“…When performed, surgery appeared relatively safe with no reported mortality, and was well tolerated with few complications, in keeping with multiple contemporary studies where mortality rates of <1% were reported. [17][18][19][20][21] Without surgery, mortality was high (5.1%) and comparable to previous studies. [6][7][8][9][10] Our study population was relatively young and predominantly male.…”

Section: Discussionsupporting

confidence: 85%

“…It has the benefits of prevention of lifethreatening haemoptysis, eradication of the pyogenic component and probable prolongation of life. [15][16][17][18][19][20][21] Although surgical resection is considered curative, it is not possible in every patient, for a variety of physiological and technical reasons. Such reasons may include poor physical condition, severe comorbidity, poor pulmonary reserve, extensive lung involvement or inability to localise the bleeding site.…”

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confidence: 99%

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Outcomes of resectable pulmonary aspergilloma and the performance gap in a high tuberculosis prevalence setting: A retrospective study

et al. 2017

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Background. Pulmonary aspergillomas develop in patients with underlying structural lung diseases. The mainstay of therapy is surgery. Objectives. To assess treatment and clinical outcomes following diagnosis of potentially resectable pulmonary aspergilloma at the Tygerberg Hospital (TBH) between January 2013 and December 2015.Methods. This was a retrospective analysis conducted at TBH. Patients were followed up between 6 and 29 months following diagnosis to analyse outcomes. Results. Fifty-nine patients presented for surgery. The mean (SD) age was 44.5 (8.8) years. Thirty-six (61.0%) were male and 13 (22.0%) were HIV-positive. A previous history of pulmonary TB was identified in 83.1% of the patients. One or both upper lobes were involved in 58 patients (98.3%) and haemoptysis was the most frequent symptom, occurring in 56 patients (94.9%). Nine patients (15.3%) were considered unfit for surgery. As of June 2016, 23 (46.0%) of the remaining 50 patients had undergone surgery and 3 (6.0%) had died before surgery was performed. The median time from multidisciplinary discussion to surgery was 190 days (interquartile range 134 -351). Twenty patients (87.0%) underwent lobectomy and 3 (13.0%) had pneumonectomy. There was no postoperative mortality. One patient developed bleeding, persistent air leak and aspiration pneumonia postoperatively. Three patients were hospitalised for >7 days postoperatively. Following surgery, only two patients reported ongoing respiratory symptoms by day 90. Conclusion. Less than half of the patients accepted for lung resection at TBH underwent surgery. Waiting times were long (>1 year in 25%) and were associated with mortality. Barriers to prompt surgery are complex, but should be addressed urgently.

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Section: Discussionsupporting

confidence: 85%

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confidence: 99%

Outcomes of resectable pulmonary aspergilloma and the performance gap in a high tuberculosis prevalence setting: A retrospective study

et al. 2017

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“…The most common symptom is hemoptysis, as in our series ( Table 2). In some series, the incidence of hemoptysis in patients with aspergilloma ranged from 50% to 83% (1,2,7,(17)(18)(19). In our series, 52 (67.53%) patients had hemoptysis, 43 with minor hemoptysis and 9 with major hemoptysis.…”

Section: Discussionmentioning

confidence: 42%

“…Shirakusa et al said that the greatest possible amount of healthy parenchyma must be spared because of the saprophytic character of the organism (17). Open thoracotomy and anatomical resection have become widely accepted as the main treatments for pulmonary aspergilloma in patients who are suitable candidates for surgery (12).…”

Section: Discussionmentioning

confidence: 99%

Surgical management of pulmonary aspergilloma: clinical experience with 77 cases

Aydoğdu¹,

Incekara²,

Şahin³

et al. 2015

Turk J Med Sci

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IntroductionPulmonary aspergilloma is the most common human disease caused by saprophytic species of the genus Aspergillus (1,2). It involves the formation of a fungus ball or mycetoma. Antifungal agents are usually ineffective and a cure can be achieved only with surgical treatment (1,3,4). Patients with an aspergilloma require surgical treatment because there is a risk of sudden life-threatening hemoptysis, and alternative medical treatments are usually ineffective. However, the surgical indications remain controversial because of the high incidence of postoperative complications (1,5,6).This retrospective study analyzed the clinical presentation, underlying lung disease, surgical indications, techniques, treatment outcomes, and postoperative complications of pulmonary aspergilloma. Materials and methodsWe operated on 77 patients for pulmonary aspergilloma between January 2000 and December 2013. The medical records were reviewed to determine the patients' history, clinical presentation, underlying lung disease, indications for surgery, surgical procedures, and postoperative complications. The subjects included 53 males (mean age: 44.26 (range: 10-73) years) and 24 females (mean age: 48.25 (range: 26-70) years).The patients were diagnosed based on history and radiological findings on a posteroanterior lung X-ray or computed tomography. We classified the lesions as simple pulmonary aspergilloma (SPA) if the lesion was welllocalized, with a thin-walled cavity smaller than 5 cm and little or no surrounding atelectasis or consolidated areas. Lesions were classified as complex pulmonary aspergilloma (CPA) if they were well-localized, thin-walled cavities larger than 5 cm or with thick walls, and surrounded by parenchymal sequelae as disseminated consolidation and atelectasis resulting from underlying lung disease, such as bronchiectasis or tuberculosis in most cases (Figure 1) (7-11).Background/aim: This retrospective study evaluated the clinical presentation, underlying lung disease, surgical indications, technique, treatment outcomes, and postoperative complications of pulmonary aspergilloma. Materials and methods:We evaluated 77 patients who underwent pulmonary resection of an aspergilloma at Atatürk Chest Diseases and Thoracic Surgery Research and Training Hospital between January 2000 and December 2013. The initial operations were 4 pneumonectomies, 24 lobectomies, 9 lobectomy plus myoplasties, 10 segmental resections, and 30 wedge resections. Six reoperations were carried out to deal with postoperative complications: 1 myoplasty, 2 completion lobectomies plus myoplasties, 2 myoplasties with rib resections, and 1 completion lobectomy. Results:The subjects comprised 53 males (mean age: 44.26 (range: 10-73) years) and 24 females (mean age: 48.25 (range: 26-70) years). The most common indication for surgery was hemoptysis in 52 patients (67.53%). The most common underlying lung disease was tuberculosis in 37 patients (48.05%). Forty patients (51.94%) had a simple pulmonary aspergilloma and 37 (48.05%) had a complex...

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“…However, postoperative complications are more frequent than in simple aspergillomas (e.g., persistent air-leak, wound infection, bronchopleural fistula (Fig. 3B), respiratory failure) [54,55,[58][59][60]. A favorable outcome and a low recurrence rate depend on a careful patient selection and the ability to fully resect the affected lung parenchyma without fungal spillage into the pleural space.…”

Section: Adverse Events Drug-drug Interaction and Therapeutic Drug Mmentioning

confidence: 99%

Treatment of Chronic Pulmonary Aspergillosis: Current Standards and Future Perspectives

et al. 2018

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Chronic pulmonary aspergillosis (CPA) complicates conditions including tuberculosis, chronic obstructive pulmonary disease and sarcoidosis, and is associated with high morbidity and mortality. Surgical cure should be considered where feasible; however, many patients are unsuitable for surgery due to extensive disease or poor respiratory function. Azoles are the only oral drug with anti-Aspergillus activity and itraconazole and voriconazole are considered as first-line drugs. A randomized controlled trial demonstrated improvement or stability in three-quarters of patients given 6 months of itraconazole, but a quarter relapsed on stopping therapy. Long-term treatment may therefore be required in some cases. Itraconazole, voriconazole and posaconazole require therapeutic drug monitoring. No published data are yet available for isavuconazole. Adverse drug effects of azoles are common, including peripheral neuropathy, heart failure, elevated liver enzymes, QTc prolongation and sun sensitivity. Many serious drug-drug interactions occur, including major interactions with rifamycins, simvastatin, warfarin, clopidogrel, immunosuppressant drugs like sirolimus. Furthermore, drug resistance occurs, including cross-resistance to all azoles, but the true prevalence is not yet determined. Intravenous therapy is possible with echinocandins or amphotericin B, but long-term use is challenging. Hemoptysis complicates CPA and can be fatal. Tranexamic acid should be given acutely to reduce bleeding. Bronchial artery embolization can stop acute bleeds. In some circumstances, emergency surgery may be necessary to resect the source of the bleed. Current CPA treatments can be beneficial but have many drawbacks. New oral anti-Aspergillus agents are needed, along with optimization of currently available treatments.

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Surgical treatment for pulmonary aspergilloma: a 35-year experience in the Chinese population

Cited by 65 publications

References 15 publications

Outcomes of resectable pulmonary aspergilloma and the performance gap in a high tuberculosis prevalence setting: A retrospective study

Outcomes of resectable pulmonary aspergilloma and the performance gap in a high tuberculosis prevalence setting: A retrospective study

Surgical management of pulmonary aspergilloma: clinical experience with 77 cases

Treatment of Chronic Pulmonary Aspergillosis: Current Standards and Future Perspectives

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