Outcome of Surgery for Chronic Pulmonary Aspergillosis, Collaborated Experience of Four Centers within the Kingdom of Saudi Arabia (KSA)

Mohamed Adel Elanwar*

Department of Cardiothoracic Surgery, Saudi German Hospitals, KSA

^*Correspondance to: Mohamed Adel Elanwar 

 PDF  Full Text DOI: 10.25107/2474-1647.2738

Abstract

Background: Aspergilloma is the most common form of pulmonary involvement by Aspergillus sp, which usually develops in a pre-existing cavity within the lung. The aspergilloma (commonly known as fungus ball) is composed of fungal hyphae, inflammatory cells, fibrin, mucus, and tissue debris. The most common species of Aspergillus recovered from such lesions is A. fumigatus. For the study, over 10 years of data were collected for examination, on the outcomes of surgery for pulmonary aspergilloma, from the respected four Saudi German Hospitals referenced within KSA. Methods: Retrospective study of forty (40) patients, dating from January 2008 until September 2018, who underwent lung resections at any one of the four institutes. Each patient’s preoperative, diagnostic, operative, and postoperative and follow-up data were collected for analysis. The indication for surgery was recurrent hemoptysis, asymptomatic simple aspergilloma and complex aspergilloma. Results: Findings of 40 patients who underwent surgery for aspergilloma, thirty-three (33) had clinical diagnosis. While, remaining seven (7) were confirmed post-resection. The median age was 41.3 years old, +/- 12.8 (aged 13 to 74 years). Risk assessment identified that greater probability for the left lung to be infected and increase if gender was male (2:1). The main presentation was hemoptysis, seen in 70% of cases, while symptoms of cough and expectoration occurred in 45% of them. The most prevalent predisposing factor was Tuberculosis (TB), present in 57.5% of cases. All the patients underwent pulmonary resection, with 82.5% of cases having lobectomy. The main postoperative complication was prolonged air leak 15% (6/40). The in-hospital mortality rate was 7.5% (3/40) patients. Conclusion: Surgery in patients with chronic pulmonary aspergillosis (fungus ball) offered beneficial outcomes with an acceptable morbidity. The mortality observed within these cases, was predominantly due to high risk patients, with complex aspergillosis. Recommendations for a multidisciplinary approach, in future cases, are paramount for better selection criteria.

Keywords

Fungus ball; Aspergilloma; Lobectomy; Aspergillus

Cite the article

Elanwar MA. Outcome of Surgery for Chronic Pulmonary Aspergillosis, Collaborated Experience of Four Centers within the Kingdom of Saudi Arabia (KSA). Clin Surg. 2020; 5: 2738.