Treatment of Pulmonary Aspergilloma- Is Surgery A Safe Option? A Review of 289 Cases at Two Centers in Pakistan

Abstract

Objective:To determine outcome of surgery in adult Pakistani population with aspergilloma.
Methods: Atotal of 289 adults of both sexes with unilateral aspergilloma cavity were enrolled in
this prospective study spanning 16 years carried out in Services Institute of Medical Sciences and
Surgimed Hospital Lahore. Out of 289, only 102 patients were electively fit for surgery. Exclusion
criteria involved any patient with extensive bilateral disease, advanced age (65+) and lack of
consent. Data was collected on hard copy forms with entry and analysis done in SPSS version 23.
Follow up period was of 36 months.
Results: Our study consisted of 289 patients with 102 selected for surgical intervention. The
median age of the patients was 33.4. The most common presenting complaint was recurrent
hemoptysis, seen in 75 patients (73.5%). The most common underlying lung pathologies
predisposing to Aspergilloma were Tuberculosis (76.4%) and Bronchiectasis (14.7%). The most
common co-morbidities were Hepatitis C 23.5% and Diabetes 20.5%. Out of 102 cases
postoperative complications were documented in 24 (23.5%) patients of which 9(37%) patients
had more than one complications.10 (9.8%) patients had prolonged air leak, 8 (7.8%) had
surgical site wound infection, 8 (7.8%) had mild hemoptysis for couple of weeks, 5(4.9%) had
bronchopleural fistula, 5(4.9%) had intra thoracic haemorrhage (>1500 ml blood loss), 4 (3.9%)
had post resection loculated empyema and 4(3.9%) had pneumonia. Post-operative mortality
was 1.96% with zero per-operative mortality. One patient died due to pulmonary embolism on 5th
postoperative day and the other patient died of myocardial infarction. Follow up was for 36 months
postoperatively.
Conclusions: Although surgical intervention for aspergilloma is technically difficult,scrupulous
selection of patients, meticulous surgical techniques and good postoperative care can reduce
mortality and morbidity and favourable outcome can be achieved.