Outcomes of resectable pulmonary aspergilloma and the performance gap in a high tuberculosis prevalence setting: A retrospective study

Abstract

Background. Pulmonary aspergillomas develop in patients with underlying structural lung diseases. The mainstay of therapy is surgery.

Objectives. To assess treatment and clinical outcomes following diagnosis of potentially resectable pulmonary aspergilloma at the Tygerberg Hospital (TBH) between January 2013 and December 2015.

Methods. This was a retrospective analysis conducted at TBH. Patients were followed up between 6 and 29 months following diagnosis to analyse outcomes.

Results. Fifty-nine patients presented for surgery. The mean (SD) age was 44.5 (8.8) years. Thirty-six (61.0%) were male and 13 (22.0%) were HIV-positive. A previous history of pulmonary TB was identified in 83.1% of the patients. One or both upper lobes were involved in 58 patients (98.3%) and haemoptysis was the most frequent symptom, occurring in 56 patients (94.9%). Nine patients (15.3%) were considered unfit for surgery. As of June 2016, 23 (46.0%) of the remaining 50 patients had undergone surgery and 3 (6.0%) had died before surgery was performed. The median time from multidisciplinary discussion to surgery was 190 days (interquartile range 134 - 351). Twenty patients (87.0%) underwent lobectomy and 3 (13.0%) had pneumonectomy. There was no postoperative mortality. One patient developed bleeding, persistent air leak and aspiration pneumonia postoperatively. Three patients were hospitalised for >7 days postoperatively. Following surgery, only two patients reported ongoing respiratory symptoms by day 90.

Conclusion. Less than half of the patients accepted for lung resection at TBH underwent surgery. Waiting times were long (>1 year in 25%) and were associated with mortality. Barriers to prompt surgery are complex, but should be addressed urgently.