Surgery for pulmonary aspergilloma in post-tuberculous vs. immuno-compromised patients

Objective: To compare the outcome of surgical resection for aspergilloma be tween patients with post-tuberculous complex and neutropenia. Methods: We r etrospectively reviewed our surgical experience with pulmonary resection fo r aspergilloma in 30 patients. Of the 20 patients with complex aspergilloma complicating healed tuberculosis (group 1), 14 were male and six were fema le with an average age of 54 years (SD 7). The indication for surgery was r ecurrent haemoptysis in all and there were 17 lobectomies, two pneumonectom ies and one bilateral lobectomy. There were ten patients with acute myeloid or lymphoid leukemia (group 2), six male and four female with an average a ge of 26 years (SD 4). Twelve lesions required lobectomy in eight and wedge excision in four. Results; In group I there was one postoperative death (5 %), in a patient with massive haemoptysis and completely destroyed lungs wi th bilateral upper lobe aspergilloma secondary to pneumonia. Morbidity acco unted for 25% (five patients), two required re-exploration for bleeding, tw o had prolonged air leak more than 7 days and one developed empyema. The la ter was treated with drainage and rib resection. One patient had recurrence of haemoptysis during the follow up period (mean 42 months). In group 2 th ere was no mortality or morbidity and six patients proceeded to bone marrow transplantation with no complication or recurrence. Conclusions: Surgical resection for pulmonary aspergilloma in selected patients provides the best chance of cure. Pulmonary resection for post-tuberculous complex aspergill oma is associated with higher morbidity than resection for immuno-compromis ed patients. (C) 2001 Elsevier Science B.V. All rights reserved.