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Fungus ball removal with video-cavernoscopy for complex aspergilloma

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Abstract

Objective

Complete resection with a clear margin is the only curative treatment for pulmonary aspergilloma. This requires a high-level technique, especially for complex aspergilloma (CA), because of patient conditions and wide dense adhesions. Fungus ball removal is used palliatively to control hemoptysis, rather than as a radical procedure, and may be performed using video-cavernoscopy as a simple and repeatable method. In this study, we examined this approach as an alternative treatment for CA.

Methods

Eight cases of fungus ball removal with video-cavernoscopy (video-cavernoscopic removal) treated at our center were retrospectively reviewed. The patient characteristics and surgical outcomes were compared with those of patients treated with one-stage radical surgery.

Results

There were 8 subjects (7 males, 1 female; median age 65 years) in the video-cavernoscopic removal group and 25 subjects (19 males, 6 females; median age 56 years) in the one-stage radical surgery group. The video-cavernoscopic removal group had a higher rate of emphysematous lung (p = 0.001), a lower body mass index (p = 0.039), and a lower percent vital capacity (p = 0.027). All cases in this group had preoperative hemoptysis that ceased after the procedure. Video-cavernoscopic removal was less invasive based on a shorter operative time (p = 0.000), less blood loss (p = 0.002), and a lower Common Terminology Criteria for Adverse Events grade (p = 0.023). However, four cases in this group (50%) relapsed with a median disease-free survival period of 471.5 days.

Conclusions

Fungus ball removal with video-cavernoscopy is a simple technique for the prevention and control of massive hemoptysis that may be an alternative treatment for CA.

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Acknowledgements

The authors thank the nursing and anesthesia staff at Kanagawa Cardiovascular and Respiratory Center.

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Authors and Affiliations

  1. Department of General Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, 236-8651, Japan

    Hiromasa Arai, Michihiko Tajiri, Noritake Kikunishi, Sho Nakamura & Kenji Inafuku

  2. Department of Respiratory Medicine, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, 236-8651, Japan

    Akimasa Sekine

  3. Department of Pathology, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Koji Okudela

  4. Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, 236-8651, Japan

    Tae Iwasawa

  5. Departoment of Surgery, Yokohoma City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Munetaka Masuda

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  1. Hiromasa Arai
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  2. Michihiko Tajiri
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  3. Noritake Kikunishi
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  4. Sho Nakamura
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  5. Kenji Inafuku
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  8. Tae Iwasawa
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  9. Munetaka Masuda
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Correspondence to Hiromasa Arai.

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Arai, H., Tajiri, M., Kikunishi, N. et al. Fungus ball removal with video-cavernoscopy for complex aspergilloma. Gen Thorac Cardiovasc Surg 69, 1400–1406 (2021). https://doi.org/10.1007/s11748-021-01645-x

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  • DOI: https://doi.org/10.1007/s11748-021-01645-x

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