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

Journal of Cardiothoracic Surgery

Kandadai Rammohan¹  David W Denning²  Rajesh Shah¹  Piotr Krysiak¹  Mark T Jones¹  Sing Y Soon¹  Malcolm Richardson²  Matthew Kneale²  Mohan Devbhandari¹  Shaza Mohamed¹  Shakil Farid¹ 

[1] Department of Thoracic Surgery, University Hospital of South Manchester, Manchester, UK;The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK

关键词: Echinocandin;    Voriconazole;    Aspergillus fumigatus;    Nodule;    Aspergilloma;   

Others  :  824195
DOI  :  10.1186/1749-8090-8-180

 received in 2013-05-14, accepted in 2013-08-01,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Farid et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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