Clinical profile and surgical outcome for different types of chronic pulmonary aspergillosis

Background: Chronic pulmonary aspergillosis (CPA) has been reclassified as several different subtypes, and the clinical features of the different types should be further investigated. Surgery is a remedial option for patients who experience pharmacological treatment failure, though more information about the effectiveness and prognosis of surgical treatment and perioperative medication for different types of CPA is needed. Methods: This was a retrospective study of patients with proven CPA who underwent surgery between January 2001 and June 2018 at Nanjing Jinling Hospital. Results: Sixty patients underwent surgery. The median age was 52.5 years (22-80), and chronic cavitary pulmonary aspergillosis (CCPA) accounted for the largest proportion of cases (46.7%). The most common presenting symptom was hemoptysis (70%). Many patients had underlying lung disease, including bronchiectasis (30%) and obsolete tuberculosis (TB) (21.7%). The surgical procedures included lobectomy (76.7%), wedge resection (16.7%), segmentectomy (5%) and pneumonectomy (1.7%). In total, 33 patients (62.3%) received perioperative antifungal treatment, all of whom improved or were cured. Conversely, 22 patients did not receive perioperative anti-Aspergillus treatment; among them, 3 patients with subacute invasive aspergillosis (SAIA) and 1 with CCPA experienced disease progression or died. Conclusions: Surgery is needed in some patients with refractory CPA. We consider that SAIA and CCPA patients may benefit from perioperative antifungal therapy. However, due to the limited number of patients in this study, more evidence is needed to draw a conclusion about this issue.