Les aspergillomes pulmonaires : résultats du traitement chirurgical. À propos d'une série de 206 cas

Pulmonary aspergilloma: results of surgical treatment. Report of 206 cases.

Study aim: The aim of this retrospective study was to report the results of the surgical treatment in 188 patients operated on for pulmonary aspergilloma in a series of 206 patients observed in Morocco.

Patients and method : From 1982 to 1998, 206 patients were treated for pulmonary aspergilloma in the same hospital ; 188 were operated on and surgery was contraindicated in the other patients with general or respiratory failure. Hemoptysis was the main symptom, present in 190 patients (92%). Surgery was performed on principle with 108 lobectomies, 38 segmentectomies, 18 lobectomies and segmentectomies, 21 pleuropneumonectomies and 3 thoracoplasties.

Results : Postoperative complications occurred in 36% of the patients including: pyothorax (n=15), hemothorax (n=10), rehabitation defects (n=17) and respiratory failure (n=10). Reoperation was necessary in 6 patients. Postoperative mortality rate was 6,4% (12 patients including 5 treated by pleuro-pneumonectomy).

Conclusion: The surgical treatment, in spite of its high morbidity, has to be proposed to all patients with pulmonary aspergilloma, even in asymptomatic patients when there is no surgical contraindication. Pleuro-pneumonectomy is a very high risk procedure and its indications must be restricted. Thoracoscopy was rarely performed in this series.