Surgery for aspergilloma and invasive aspergillosis
Dr Gilbert Massard
Hôpitaux Universitaires de Strasbourg, France

Dr Massard discusses the options for surgery in aspergilloma and invasive aspergillosis. 

Surgical resection should be considered for only the most dangerous of lesions. Factors predicting a low rate of operative complication are youth, lack of underlying lung disease and limited resection; operative death rate for this procedure is about 10%. 

Surgery may be considered for removal of a small part of a lung, a lobe or a complete lung, but the greater the amount removed, the greater the danger for the patient. For simple aspergilloma, the operative risk is low, but in complex aspergilloma, where the lesion may be larger, and there may be underlying lung disease, poor respiratory function, poor nutrition etc., both the operative risk and spontaneous risk are increased.

Despite the introduction of antifungals, surgery has a broad spectrum of indications in aspergilloma and invasive aspergillosis, although a well-trained thoracic surgeon is needed to carry it out.

Surgery has become more successful, with fewer complications and shorter periods of hospitalisation. It is important that surgery is complemented by other treatments, including nutrition, treatment of infection, chest physiotherapy, exercise training, psychological support and social support. However, there is a high risk of complications for those with symptoms, and the risks and benefits of surgery need to be carefully weighed.

With thanks to Fran Stokes