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Ann Thorac Surg 2001;72:889-893
© 2001 The Society of Thoracic Surgeons

Original article: general thoracic

Surgical outcome of pulmonary resection in chronic necrotizing pulmonary aspergillosis

Shunsuke Endo, MDa, Yasunori Sohara, MDa, Fumio Murayama, MDa, Tsutomu Yamaguchi, MDa, Tsuyoshi Hasegawa, MDa, Kenji Tezuka, MDa, Shin-ichi Yamamoto, MDa

a Department of Thoracic Surgery, Jichi Medical School, Tochigi, Japan

Accepted for publication May 16, 2001.

Address reprint requests to Dr Endo, Department of Thoracic Surgery, Jichi Medical School, Minamikawachi-machi, Kawachi-gun, Tochigi 329-0498, Japan
e-mail: tcvshun{at}jichi.ac.jp

Background. Surgical treatment of chronic necrotizing pulmonary aspergillosis is hazardous and controversial.

Methods. Ten patients (8 men, 2 women; mean age, 50 years) with chronic necrotizing pulmonary aspergillosis underwent pulmonary resection between 1989 and 2000. Single segmentectomy or lobectomy, pneumonectomy, or bilobectomy and multisegmentectomy were performed. Clinicopathologic features of these patients were reviewed to clarify the role of surgical intervention for chronic necrotizing pulmonary aspergillosis.

Results. The mean time from the onset of clinical symptoms to operation was 5.3 years. Surgical intervention was undertaken because of prolonged illness in 4 patients and hemoptysis in 6 patients. All patients survived. Three major complications (1 late empyema, 2 bronchopleural fistulas) occurred in the large dead space in the right pleural cavity. All survivors were free of aspergillosis at a mean follow-up time of 4.8 years, and only 1 patient required antifungal drugs for relapse during the follow-up period.

Conclusions. Aggressive pulmonary resection in chronic necrotizing pulmonary aspergillosis should be considered when patients have prolonged illness or frequent hemoptysis. Empyema and bronchopleural fistula are the main complications. Concomitant thoracoplasty or intrathoracic transposition of the chest wall musculature is recommended in cases involving a large residual pleural cavity on the right side.


Related Article

Invited commentary
Jeffrey M. Piehler
Ann. Thorac. Surg. 2001 72: 894. [Extract] [Full Text] [PDF]





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