Cavernostomy x Resection for Pulmonary Aspergilloma: A 32-Year History

Cases of pulmonary aspergilloma operated upon between 1979 and 2010 were analyzed retrospectively. Group 1 consisted of patients submitted to cavernostomy and group 2 of patients submitted to pulmonary parenchyma resection. The following variables were compared between groups: gender, age, number of hospitalizations, pre- and postoperative length of hospital stay, time of follow-up, location and type of aspergilloma, preoperative symptoms, underlying disease, type of fungus, preoperative pulmonary function, postoperative complications, patient progression, and associated diseases.A total of 208 patients with pulmonary aspergilloma were studied (111 in group 1 and 97 in group 2). Group 1 was older than group 2. The number of hospitalizations, length of hospital stay and time of follow-up were higher in group 1. Hemoptysis was the most frequent preoperative symptom in group 1. Preoperative respiratory malfunction was more severe in group 1. Hemorrhagic complications and recurrence were more frequent in group 1 and infectious complications and residual pleural space were more common in group 2. Postoperative dyspnea was more frequent in group 2. Patient progression was similar in the two groups. No difference in the other factors was observed between groups.Older patients with severe preoperative respiratory malfunction and peripheral pulmonary aspergilloma should be submitted to cavernostomy. The remaining patients can be treated by pulmonary resection.Controversies still exist regarding the most adequate surgical technique for the treatment of pulmonary aspergilloma despite decades of investigation. Some authors defend surgical treatment in all cases, even when asymptomatic, due to the risk of hemoptysis [1-11]. Other investigators indicate surgery only for symptomatic cases in view of the high rates of surgical morbidity and mortality [2,5,12-21]. Cavernostomy has only been indicated for the treatment of severely ill patients [5,17] whose clinical condition does not