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Results of surgery for chronic pulmonary Aspergillosis, optimal antifungal therapy and proposed high risk factors for recurrence--a National Centre's experience.

Farid S, Mohamed S, Devbhandari M, Kneale M, Richardson M, Soon SY, Jones MT, Krysiak P, Shah R, Denning DW, Rammohan K - J Cardiothorac Surg (2013)

Bottom Line: The procedures included lobectomy 50% (n = 15), pneumonectomy 10% (n = 3), sublobar resection 27% (n = 8), decortication 7% (n = 2), segmentectomy 3% (n = 1), thoracoplasty 3% (n = 1), bullectomy and pleurectomy 3% (n = 1), 6% (n = 2) lung transplantation for associated disease.Recurrence of CCPA was noted in 8 patients (26%), most having prior CCPA (75%).Taurolidine 2% was active against all 9 A. fumigatus isolates and used for pleural decontamination during surgery.

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ABSTRACT

Background: Surgery for pulmonary aspergillosis is infrequent and often challenging. Risk assessment is imprecise and new antifungals may ameliorate some surgical risks. We evaluated the medical and surgical management of these patients, including perioperative and postoperative antifungal therapy.

Methods: Retrospective study of patients who underwent surgery for pulmonary aspergillosis between September 1996 and September 2011.

Results: 30 patients underwent surgery with 23 having a preoperative tissue diagnosis while 7 were confirmed post-resection. The median age was 57 years (17-78). The commonest presenting symptoms were cough (40%, n = 12) and haemoptysis (43%, n = 13). Twelve (40%) patients had simple aspergilloma (including 2 with Aspergillus nodules) while the remaining 18 (60%) had chronic cavitary pulmonary aspergillosis (CCPA) (complex aspergilloma). Most of the patients had underlying lung disease: tuberculosis (20%, n = 6), asthma (26%, n = 8) and COPD (20%, n = 6). The procedures included lobectomy 50% (n = 15), pneumonectomy 10% (n = 3), sublobar resection 27% (n = 8), decortication 7% (n = 2), segmentectomy 3% (n = 1), thoracoplasty 3% (n = 1), bullectomy and pleurectomy 3% (n = 1), 6% (n = 2) lung transplantation for associated disease. Median hospital stay was 9.5 days (3-37). There was no operative and 30 day mortality. Main complications were prolonged air leak (n = 7, 23%), empyema (n = 6, 20%), respiratory failure requiring tracheostomy /reintubation (n = 4, 13%). Recurrence of CCPA was noted in 8 patients (26%), most having prior CCPA (75%). Taurolidine 2% was active against all 9 A. fumigatus isolates and used for pleural decontamination during surgery.

Conclusions: Surgery in patients with chronic pulmonary aspergillosis offered good outcomes with an acceptable morbidity in a difficult clinical situation; recurrence is problematic.

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Survival curve of the patients who underwent surgery for simple and chronic pulmonary aspergillosis.
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Figure 2: Survival curve of the patients who underwent surgery for simple and chronic pulmonary aspergillosis.

Mentions: Most of our patients underwent pulmonary resection. In cases with localised unilateral disease, a wedge resection was carried out where possible to preserve lung tissue. Some authorities believe that because of the saprophytic nature of the organism parenchymal preservation is preferable provided that the rest of the underlying lung is healthy [11]. These patients who underwent a localised resection had a better outcome and in most of them postoperative antifungal therapy could be stopped. The more complex group of patients in our series who underwent surgery to deal with complications like empyema and haemoptysis had a worse outcome (Figure 2).


Results of surgery for chronic pulmonary Aspergillosis, optimal antifungal therapy and proposed high risk factors for recurrence--a National Centre's experience.

Farid S, Mohamed S, Devbhandari M, Kneale M, Richardson M, Soon SY, Jones MT, Krysiak P, Shah R, Denning DW, Rammohan K - J Cardiothorac Surg (2013)

Survival curve of the patients who underwent surgery for simple and chronic pulmonary aspergillosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750592&req=5

Figure 2: Survival curve of the patients who underwent surgery for simple and chronic pulmonary aspergillosis.
Mentions: Most of our patients underwent pulmonary resection. In cases with localised unilateral disease, a wedge resection was carried out where possible to preserve lung tissue. Some authorities believe that because of the saprophytic nature of the organism parenchymal preservation is preferable provided that the rest of the underlying lung is healthy [11]. These patients who underwent a localised resection had a better outcome and in most of them postoperative antifungal therapy could be stopped. The more complex group of patients in our series who underwent surgery to deal with complications like empyema and haemoptysis had a worse outcome (Figure 2).

Bottom Line: The procedures included lobectomy 50% (n = 15), pneumonectomy 10% (n = 3), sublobar resection 27% (n = 8), decortication 7% (n = 2), segmentectomy 3% (n = 1), thoracoplasty 3% (n = 1), bullectomy and pleurectomy 3% (n = 1), 6% (n = 2) lung transplantation for associated disease.Recurrence of CCPA was noted in 8 patients (26%), most having prior CCPA (75%).Taurolidine 2% was active against all 9 A. fumigatus isolates and used for pleural decontamination during surgery.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Surgery for pulmonary aspergillosis is infrequent and often challenging. Risk assessment is imprecise and new antifungals may ameliorate some surgical risks. We evaluated the medical and surgical management of these patients, including perioperative and postoperative antifungal therapy.

Methods: Retrospective study of patients who underwent surgery for pulmonary aspergillosis between September 1996 and September 2011.

Results: 30 patients underwent surgery with 23 having a preoperative tissue diagnosis while 7 were confirmed post-resection. The median age was 57 years (17-78). The commonest presenting symptoms were cough (40%, n = 12) and haemoptysis (43%, n = 13). Twelve (40%) patients had simple aspergilloma (including 2 with Aspergillus nodules) while the remaining 18 (60%) had chronic cavitary pulmonary aspergillosis (CCPA) (complex aspergilloma). Most of the patients had underlying lung disease: tuberculosis (20%, n = 6), asthma (26%, n = 8) and COPD (20%, n = 6). The procedures included lobectomy 50% (n = 15), pneumonectomy 10% (n = 3), sublobar resection 27% (n = 8), decortication 7% (n = 2), segmentectomy 3% (n = 1), thoracoplasty 3% (n = 1), bullectomy and pleurectomy 3% (n = 1), 6% (n = 2) lung transplantation for associated disease. Median hospital stay was 9.5 days (3-37). There was no operative and 30 day mortality. Main complications were prolonged air leak (n = 7, 23%), empyema (n = 6, 20%), respiratory failure requiring tracheostomy /reintubation (n = 4, 13%). Recurrence of CCPA was noted in 8 patients (26%), most having prior CCPA (75%). Taurolidine 2% was active against all 9 A. fumigatus isolates and used for pleural decontamination during surgery.

Conclusions: Surgery in patients with chronic pulmonary aspergillosis offered good outcomes with an acceptable morbidity in a difficult clinical situation; recurrence is problematic.

Show MeSH
Related in: MedlinePlus