Predictors of Long-Term Survival of Thoracoscopic Lobectomy for Stage IA Non-Small Cell Lung Cancer: A Large Retrospective Cohort Study.

The standard of care for patients with early-stage non-small cell lung cancer (NSCLC) is anatomical lung resection with lymphadenectomy. This multicenter, retrospective, cohort study aimed to identify predictors of 5-year survival in patients after thoracoscopic lobectomy for stage IA NSCLC. The study included 1249 patients who underwent thoracoscopic lobectomy for stage IA NSCLC between 17 April 2007, and December 28, 2016. The 5-year survival rate equaled 77.7%. In the multivariate analysis, higher age (OR, 1.025, 95% CI: 1.002 to 1.048; p = 0.032), male sex (OR, 1.410, 95% CI: 1.109 to 1.793; p = 0.005), chronic obstructive pulmonary disease (OR, 1.346, 95% CI: 1.005 to 1.803; p = 0.046), prolonged postoperative air leak (OR, 2.060, 95% CI: 1.424 to 2.980; p < 0.001) and higher pathological stage (OR, 1.271, 95% CI: 1.048 to 1.541; p = 0.015) were related to the increased risk of death within 5 years after surgery. Lobe-specific mediastinal lymph node dissection (OR, 0.725, 95% CI: 0.548 to 0.959; p = 0.024) was related to the decreased risk of death within 5 years after surgery. These findings provide valuable insights for clinical practice and may contribute to improving the quality of treatment of early-stage NSCLC.

Identification of Factors Related to the Quality of Lymphadenectomy for Lung Cancer: Secondary Analysis of Prospective Randomized Trial Data.

The outcomes of non-small cell lung cancer surgery are influenced by the quality of lymphadenectomy. This study aimed to evaluate the impact of different energy devices on lymphadenectomy quality and identify additional influencing factors. This secondary analysis of the prospective randomized trial data (clinicaltrials.gov: NCT03125798) compared patients who underwent thoracoscopic lobectomy with the LigaSure device (study group, n = 96) and monopolar device (control group, n = 94). The primary endpoint was the lobe-specific mediastinal lymphadenectomy. Lobe-specific mediastinal lymphadenectomy criteria were met in 60.4% and 38.3% of patients in the study and control groups, respectively (p = 0.002). In addition, in the study group, the median number of mediastinal lymph node stations removed was higher (4 vs. 3, p = 0.017), and complete resection was more often achieved (91.7% vs. 80.9%, p = 0.030). Logistic regression analysis indicated that lymphadenectomy quality was positively associated with the use of the LigaSure device (OR, 2.729; 95% CI, 1.446 to 5.152; p = 0.002) and female sex (OR, 2.012; 95% CI, 1.058 to 3.829; p = 0.033), but negatively associated with a higher Charlson Comorbidity Index (OR, 0.781; 95% CI, 0.620 to 0.986; p = 0.037), left lower lobectomy (OR, 0.263; 95% CI, 0.096 to 0.726; p = 0.010) and middle lobectomy (OR, 0.136; 95% CI, 0.031 to 0.606, p = 0.009). This study found that using the LigaSure device can improve the quality of lymphadenectomy in lung cancer patients and also identified other factors that affect the quality of lymphadenectomy. These findings contribute to improving lung cancer surgical treatment outcomes and provide valuable insights for clinical practice.

Upfront surgery for N2 NSCLC: a large retrospective multicenter cohort study.

BACKGROUND: The optimal sequence and combination of surgery, chemotherapy and radiotherapy in patients with N2 non-small cell lung cancer (NSCLC) remain undefined. The aim of our study was to compare two treatment options for N2 NSCLC-induction therapy with subsequent surgery versus upfront surgery with adjuvant treatment. METHODS: We retrospectively reviewed 405 patients with N2 disease in two centers, between January 2010 and December 2016. They were divided into two groups: the Induction Group, composed of patients who received neoadjuvant chemotherapy, and the Upfront surgery Group, composed of patients who underwent surgery as first-line therapy. Propensity score-matched (PSM) analysis was performed, and 52 patients were included in each group. Primary endpoints were: recurrence, overall survival (OS) and disease-free survival (DFS). RESULTS: After the PSM, no differences were observed in general characteristics, perioperative results, rates and severity of complications, and histopathology results. Seventeen patients (32.7%) of the induction group and 21 (40.4%) of the upfront surgery group had mediastinal lymph nodal involvement with skipping (p = 0.415). Recurrence rate was not different between the two groups (57.7% vs 50.0%, p = 0.478). No differences were observed in terms of OS (40.98 ± 35.78 vs 37.0 ± 40.69 months, p = 0.246) and DFS (29.67 ± 36.01 vs 27.96 ± 40.08 months, p = 0.697). The multivariable analysis identified the pT stage and skipping lymph node metastasis as independent predictive factors for OS. CONCLUSIONS: Upfront surgery followed by adjuvant therapy does not appear inferior in terms of recurrence, OS and DFS, compared to induction chemotherapy with subsequent surgery.

Comparison of the LigaSure™ bipolar vessel sealer to monopolar electrocoagulation for thoracoscopic lobectomy and lymphadenectomy: a prospective randomized controlled trial.

BACKGROUND: High-energy devices allow better vessel sealing compared with monopolar electrocautery and could improve the outcomes of surgical operations. The objective of the study was to compare tissue dissection by the LigaSure™ device with that by monopolar electrocoagulation for thoracoscopic lobectomy and lymphadenectomy. METHODS: This pragmatic, parallel group, prospective randomized controlled trial was funded by the Medtronic External Research Program (ISR-2016-10,756) and registered at www. CLINICALTRIALS: gov (NCT03125798). The study included patients aged 18 years or older, who had undergone thoracoscopic lobectomy with lymphadenectomy at the Department of Thoracic Surgery of Poznan University of Medical Sciences between May 3, 2018, and November 4, 2021. Using simple randomization, the patients were assigned to undergo tissue dissection with either the LigaSure device (study group) or monopolar electrocautery (control group). Participants and care givers, except operating surgeons, were blinded to group assignment. The primary outcome was postoperative chest drainage volume. Secondary outcomes were change of the esophageal temperature during subcarinal lymphadenectomy and C-reactive protein level 72 h after surgery. RESULTS: Study outcomes were analyzed in 107 patients in each group. We found no differences between the study and control groups in terms of chest drainage volume (550 vs. 600 mL, respectively; p = 0.315), changes in esophageal temperature (- 0.1 °C vs. - 0.1 °C, respectively; p = 0.784), and C-reactive protein levels (72.8 vs. 70.8 mg/L, respectively; p = 0.503). The mean numbers of lymph nodes removed were 12.9 (SD: 3.1; 95% CI, 12.4 to 13.5) in the study group and 11.6 (SD: 3.2; 95% CI, 11.0 to 12.2) in the control group (p < 0.001). CONCLUSIONS: The use of the LigaSure device did not allow to decrease the chest drainage volume, local thermal spread, and systemic inflammatory response. The number of lymph nodes removed was higher in patients operated with the LigaSure device, which indicated better quality of lymphadenectomy.

Outcomes of lung cancer surgery in patients with COVID-19 history: a single center cohort study.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) can irreversibly damage the lungs and could possibly increase the risk of surgical treatment of lung cancer. The study aimed to assess the relationship between preoperative COVID-19 and complications and early outcomes of lung cancer surgery. METHODS: This single-center cohort study included 444 patients who underwent lobectomy or segmentectomy for primary lung cancer from January 1, 2019 to December 31, 2021. The exclusion criteria were pneumonectomy, extended resection, and wedge resection. The groups of patients with (n = 72) and without (n = 372) the history of COVID-19 prior to surgery were compared. The groups were similar in terms of distribution of baseline, surgical and histopathological characteristics. The primary endpoint was the incidence of postoperative complications. Secondary endpoints were outcomes at discharge and at 90 days. RESULTS: The incidence of postoperative complications did not differ between the groups of patients with and without COVID-19 history (30.6% vs 29.3%, p = 0.831). Outcomes at discharge and at 90 days after surgery did not differ between the groups. Among the patients with and without prior COVID-19, 97.2 and 99.5% were alive at discharge (p = 0.125), and 97.2% and 98.1% ninety days after surgery (p = 0.644), respectively. Patients with COVID-19 history more often required re-drainage (6.9% v 2.2%, p = 0.044) and reoperation (5.6 v 1.3%, p = 0.042). CONCLUSIONS: COVID-19 history is not related to the general incidence of complications, outcomes at discharge from the hospital, and at 90-days after surgery.

The technique of stump closure has no impact on post-pneumonectomy bronchopleural fistula in the non-small cell lung cancer-a cross-sectional study.

Background: Pneumonectomy is a high-risk radical resection procedure, with bronchopleural fistula (BPF) being its most challenging and severe complication. This study aimed to assess the surgical risk factors and the impact of the bronchial stump closure technique on the incidence of the BPF. Methods: This is a single-center, cross-sectional study of the medical records of 455 post-pneumonectomy patients operated due to non-small cell lung cancer (NSCLC) in 2006-2017. We analyzed the following variables and their influence on the occurrence of the BPF: operation side, surgical techniques (i.e., manual suture or the stapler), stump buttressing, the extension of pneumonectomy, comorbidities, and postoperative complications. Results: BPF occurred in 7.47% of post-pneumonectomy patients. BPF was more prevalent in right-sided pneumonectomy versus left-sided (10.98% vs. 5.32%; P=0.026). The use of a stapler or manual suture was not associated with the incidence of the BPF (7.96% vs.7.09%, P=0.72). There were no significant differences in the occurrence of BPF among bronchial stump buttressing with the parietal pleura (P=0.80), intercostal muscle flap (IMF) (P=0.46), and pericardial fat pad (P=0.88). When comparing data from 2006-2012 with those from 2013-2017, we found a steady decrease in the number of performed stump reinforcements, but this was not associated with a higher risk of BPF. Conclusions: The method used for stump closure, additional tissue buttressing of the bronchial stump and year of the surgery had no significant impact on the occurrence of BPF. Only right-sided pneumonectomy was associated with higher BPF occurrence.

Surgical Management of Primary Spontaneous Pneumothorax Without Lung Bullae.

INTRODUCTION: Primary spontaneous pneumothorax (PSP) is a relatively common disease. Different studies have been published but lung resection, when no emphysema-like changes (ELC) are detected, is unclear. The aim of our study is to retrospectively investigate the role of lung resection of the apex of the lung in patients with no ELC. METHODS: This is a retrospective multicenter study of 516 patients who underwent surgical treatment of PSP with no ELC between January 2007 and December 2017. Patients were divided into two groups: pleurodesis alone group, only mechanical pleurodesis performed (53 patients), and apical resection group, apical resection of the lung and mechanical pleurodesis performed (463 patients). The following were the primary end points considered: recurrence rate and perioperative complications; the following were the secondary end points considered: length of stay, chest tube removal, residual pleural space, prolonged air leak, and reoperation rate. RESULTS: No differences were found in the baseline and operative characteristics of the two groups. Both primary end points were statistically different: recurrence rate (15.1% versus 6.5%, P = 0.023) and perioperative complications (18.9% versus 7.3%, P = 0.004). Among secondary end points length of stay (6.94 versus 5.55, P = 0.033) and prolonged air leak (15.1% versus 4.3%, P = 0.001) were statistically different. On multivariate analysis, lung resection emerged as a protective factor for recurrence (hazard ratio 0.182, P < 0.001). CONCLUSIONS: In our experience, apical lung resection in patients without ELC may reduce recurrence rate and perioperative complications when compared with pleurodesis alone.

Catamenial pneumothorax - are there benefits of cooperation between the surgeon and the gynaecologist?

Catamenial pneumothorax (CP) is an uncommon disease related to thoracic endometriosis or diaphragmatic perforation. It is defined as an occurrence of spontaneous pneumothorax around the time of menstruation in the population of women of reproductive age with no other lung diseases. Catamenial pneumothorax is often misdiagnosed and classified as a spontaneous pneumothorax, and no in-depth gynaecological diagnostic is performed. Here we present 3 cases of female patients admitted to the Department of Thoracic Surgery with the aim of surgical treatment of recurrent CP. In all 3 cases, a temporal association between pneumothorax and menstruation was identified. In 2 presented cases the patients were diagnosed with endometriosis and other gynaecological diseases. The previous incidents of CP were treated conservatively, with suction drainage of the pleural cavity or with thoracocentesis, but the treatment did not prevent relapses. In the Department of Thoracic Surgery, each patient was operated on with the use of video-assisted thoracoscopic surgery, which is considered to be a good therapeutic option. In the case of 2 patients the surgery eliminated the relapses, 1 patient required radical lung decortication. The literature on the subject indicates the potential benefits of hormonal treatment of CP. It is suggested that using such pharmacological treatment may reduce the risk of relapse after surgery.

Short- and long-term outcomes of thoracoscopic pneumonectomy - single center experience.

INTRODUCTION: The video-assisted thoracic surgery (VATS) approach is widely used for pulmonary lobectomy, but its application for pneumonectomy is much less common and outcomes are ambiguous. AIM: To evaluate the feasibility and outcomes of VATS pneumonectomy. MATERIAL AND METHODS: This retrospective study included 19 patients with the mean age of 62.6 ±5.5 years who were qualified for VATS pneumonectomy between September 1, 2010, and January 31, 2020. Indications and technical aspects were analyzed. Moreover, short- and long-term outcomes were assessed. RESULTS: There were no intraoperative deaths. Conversion to thoracotomy was necessary in 2 (10.5%) patients, because of bleeding in 1 patient and technical reasons in another. One patient died during the in-hospital period due to multi-organ failure as a result of bronchopleural fistula. Five other subjects developed postoperative complications, most often atrial fibrillation (n = 3). One patient was readmitted for empyema of the postpneumonectomy space without bronchopleural fistula. Histopathological examination revealed that the resection was complete (R0) in all cases and the most common type of cancer was squamous cell carcinoma (79%). Seven patients died during the follow-up: 1 because of surgical complications, 4 as a result of cancer progression, and 2 for non-cancer related reasons. Median survival was 47 months. One- and five-year probability of survival estimated by means of the Kaplan-Meier method was 0.88 ±0.07 and 0.43 ±0.15, respectively. CONCLUSIONS: VATS pneumonectomy can be performed safely, without increased risk of intraoperative and postoperative complications. It enables a complete lung cancer resection and is likely to provide good short- and long-term outcomes.

Worse outcomes after conversion of thoracoscopic lobectomy for lung cancer.

OBJECTIVES: Conversion of thoracoscopic lobectomy for lung cancer to thoracotomy can adversely affect short-term outcomes, but the impact on long-term outcomes is unknown. This study aimed to identify the risk factors for conversion and to determine the influence of conversion on the outcomes of lung cancer treatment. METHODS: This retrospective study included 1002 consecutive patients with lung cancer who underwent thoracoscopic lobectomy between 7 June 1999 and 17 July 2018. The groups of patients with and without conversion were compared in terms of possible risk factors and the short- and long-term outcomes. The survival of patients was analysed by the Kaplan-Meier method. RESULTS: Conversion was done in 105 patients (10.5%). On multivariable logistic regression analysis, the independent risk factors for conversion were pleural adhesions (P < 0.001) and mediastinal lymph node metastases (P < 0.001). Compared with the non-conversion group, the conversion group had longer chest drainage time (4 vs 3 days, P < 0.001) and hospital stay (8 vs 6 days, P < 0.001); more frequent complications (38.1% vs 27.1%, P = 0.018), including red blood cell transfusion (10.5% vs 2%, P < 0.001) and supraventricular arrhythmia (13.3% vs 7.5%, P = 0.037); and lower 5-year survival rate in patients with stage I lung cancer (70% vs 87%, P = 0.014). Conversion did not increase in-hospital mortality. CONCLUSIONS: Pleural adhesions and lymph node metastases increased the probability of conversion to thoracotomy. Conversion adversely affected the short-term outcomes of thoracoscopic lobectomy. Long-term outcomes of treatment of non-small-cell lung cancer could be worse in patients after conversion, but definitive conclusions cannot be made in this regard because of the absence of control of selection bias.

Endoscopic vacuum assisted closure of esophagogastric anastomosis dehiscence: A case report.

BACKGROUND: Esophagogastric leakage is one of the most severe postoperative complications. Partial disruption of the anastomosis, can be successfully treated with an endoscopic vacuum assisted closure (E-VAC). The advantage of that method of treatment is the ability to adjust a vacuum dressing individually to the size of the dehiscence and thus to reduce the risk of a secondary fistula or abscess. The authors present two patients with postoperative gastroesophageal leakage treated successfully with E-VAC. CASE SUMMARY: Two male patients developed a potentially life threatening esophagogastric leakage. Patient A underwent resection of the distal half of the esophagus and upper part of the stomach due to Siewert type II adenocarcinoma of the gastroesophageal junction. Proximal resection of the stomach was performed in the patient B after massive bleeding from Mallory-Weiss tears. Both patients were treated successfully with an individually adapted E-VAC with concomitant correction of fluid and electrolyte disturbances, and treatment of sepsis with appropriate antibiotics. CONCLUSION: Endoscopic vacuum closure is an effective alternative to endoscopic stenting or relaparotomy. Through individual approach it allows a more accurate assessment of healing.

Serum lipidome screening in patients with stage I non-small cell lung cancer.

The ability of early lung cancer diagnosis is an unmet need in clinical practice. Lung cancer metabolomic analyses conducted so far have demonstrated several abnormalities in cancer lipid profile providing a rationale for further study of blood lipidome of the patients. In the present research, we performed a targeted lipidome screening to select molecules that show promise for early lung cancer detection. The study was conducted on serum samples collected from newly diagnosed, stage I non-small cell lung cancer (NSCLC) patients and non-cancer controls. A high-throughput mass spectrometry-based platform with confirmed interlaboratory reproducibility was used. The analyzed profile consisted of acylcarnitines, sphingomyelins, phosphatidylcholines and lysophosphatidylcholines. Among the assayed lipid species, the significant differences between NSCLC and non-cancer subjects were observed in the group of phosphatidylcholines (PC) and lysophosphatidylcholines (lysoPC), especially in the levels of lysoPC a C26:0; lysoPC a C26:1; PC aa C42:4; and PC aa C34:4. The metabolites mentioned above were used to create a multivariate classification model, which reliability was proved by permutation tests as well as external validation. Our study indicated choline-containing phospholipids as potential lung cancer markers. Further investigations of phospholipidome are crucial to better describe the shifts in metabolite composition occurring in lung cancer patients.

Pneumonectomy - permanent injury or still effective method of treatment? Early and long-term results and quality of life after pneumonectomy due to non-small cell lung cancer.

INTRODUCTION: Despite the constant decrease of performed pneumonectomies (PN) in recent years, it is still necessary for 15-20% of patients with non-small cell lung cancer (NSCLC) to undergo total lung resection due to the local progression of the disease. AIM: To assess the frequency and type of postoperative complications, quality of life, and the early and long-term results after PN performed due to NSCLC. MATERIAL AND METHODS: In the total group of 1160 patients, operated on in 2008-2011 due to NSCLC, 192 of them underwent PN (16.6%). The quality of life was analysed using EORTC-QLQ-C30 questionnaire. RESULTS: Perioperative mortality after PN was 4%. Five-year survival reached 45%. The factors that significantly affected the 5-year survival in multivariate analysis were: pTNM stage, pN stage, intrapericardial resection, and additional extrapulmonary structures resection. The mean Global Quality of Life was 50.8. The Symptom Scale ranged from 7 to 54.3, the Functional Scale from 58.2 to 76.3 and the rate for NSCLC symptoms ranged from 2.2 to 48.1. CONCLUSIONS: Pneumonectomies in patients with NSCLC is associated with higher risk of postoperative complications but it does not significantly increase the perioperative mortality. Long-term results in this group of patients are encouraging. According to the questionnaire, the quality of life is favourable. Low intensity of typical NSCLC symptoms was observed. The appropriate qualification for right-sided PN and exclusion of metastasis in N2 nodes are crucial.

Impact of smoking history on postoperative complications after lung cancer surgery - a study based on 286 cases.

AIM: The aim of the study was to evaluate the impact of smoking cessation and its timing in the preoperative period on postoperative morbidity in patients undergoing surgery for non-small cell lung cancer (NSCLC). MATERIAL AND METHODS: Two hundred and eighty-six patients surgically treated for NSCLC were prospectively analyzed in terms of duration and intensity of smoking, time period from smoking cessation to surgery, and postoperative morbidity. The patients were divided into five groups: I - current smokers and past smokers who quit smoking less than 2 weeks before surgery (n = 67), II - past smokers who quit 2 weeks to 3 months (n = 106), III - past smokers who quit 3 months to 1 year (n = 30), IV - past smokers who quit more than 1 year (n = 71), V - never smokers (n = 12). RESULTS: In the analyzed group 95.8% were smokers or past smokers. Postoperative complications occurred in 40.2% of patients including pulmonary (21.3%) and cardiac morbidity (17.8%). The pulmonary and circulatory morbidity rates were the lowest in group V but the differences were not significant. Similarly, there were no significant differences between groups with and without pulmonary or circulatory complications regarding: number of daily smoked cigarettes, smoking duration and the moment of cessation. The analysis of segmental regression showed the smallest percentage of complications in patients who quit smoking between the 8th and the 10th week before the operation. CONCLUSIONS: Among patients surgically treated for NSCLC, duration of smoking and number of smoked cigarettes has no significant influence on frequency and type of postoperative complications. The best moment to quit smoking is the period between the 8th and the 10th week preceding surgery.

Long-term results of surgical treatment of non-small cell lung cancer in patients over 75 years of age.

INTRODUCTION: Patients over 75 years of age, who, in addition, often have already exceeded the average life expectancy, in the Polish population on average 77.4 years, are the subject of discussion concerning the most appropriate choice of treatment. AIM: To analyse the long-term results in elderly patients over 75 years of age with lung cancer who underwent curative pulmonary resection. MATERIAL AND METHODS: 166 patients aged from 75 to 85 (mean: 77.4 ±2.3) operated on for non-small cell lung cancer (NSCLC) were included in this study. There were 128 (77%) men and 38 (23%) women. RESULTS: Lobectomy, including bilobectomy, was performed in 122 (74%) patients, pneumonectomy in 8 (5%) patients, and wedge resections or segmentectomy in the remaining 36 patients. Squamous or adenocarcinoma was diagnosed in 46% and 42% of cases respectively. Clinical stage I A was diagnosed in 36 (22%) patients, I B in 51 (31%), IIA in 30 (18%), IIB in 19 (11%) and IIIA in 30 (18%) of our cases. The early 30-day postoperative mortality was 5% whilst postoperative morbidity occurred in 47% of cases. The five-year survival rate was 30%. In statistical analysis, the TNM classification (p = 0.0490), the number of postoperative complications (p = 0.0001) and obstructive atelectasis requiring repeat bronchofibroscopic aspirations (p = 0.0137) in the early postoperative period most negatively influenced the long-term survival in the whole study group. CONCLUSIONS: Surgical resections for lung cancer in patients over 75 years of age are characterised by a relatively good long-term prognosis. Careful and strictly detailed preoperative selection, particularly of patients with pulmonary comorbidities and the earliest possible diagnosis of a lung tumour, can reduce the occurrence of these postoperative complications in elderly patients, which negatively influence long-term results.

Surgical treatment for pulmonary aspergilloma - early and long-term results.

INTRODUCTION: Pulmonary aspergilloma is a difficult therapeutic problem due to the low effectiveness of conservative treatment and high surgical morbidity. AIM: To analyze the early and late results of surgical treatment for pulmonary aspergilloma. MATERIAL AND METHODS: From 2005 to 2015, 49 patients were treated surgically for pulmonary aspergilloma. Symptoms occurred in 85.7% of cases, including recurrent hemoptysis in 53%. A history of immunosuppressive therapy or chemotherapy was noted in 24.5% of patients. Complex aspergilloma was diagnosed in 79.6% of cases. Immunological test results were positive in 10.2%, and bronchoalveolar lavage samples were positive for Aspergillus species in 18.5% of cases. In 59.2% of patients, the surgical risk was assessed as ASA 3. Thirty seven patients underwent lobectomy, 3 - pneumonectomy, 7 - wedge resection, 1 - decortication, and 1 - cavernostomy. RESULTS: In-hospital mortality was 4.1%. Postoperative complications occurred in 63.3% of patients. The most common complications were: prolonged air leak (26.3%), arrhythmias (20.4%), residual pneumothorax (16.3%), respiratory failure (14.3%), atelectasis (12.3%), and bleeding (12.3%). Of the three patients that underwent pneumonectomy, one died, two required repeat thoracotomy because of bleeding, and all three required prolonged mechanical ventilation. Two patients died during the follow-up period. Aspergilloma did not recur in any of the patients who underwent pulmonary resection. CONCLUSIONS: Due to the high risk of complications, surgical treatment of pulmonary aspergilloma should be restricted to symptomatic patients in whom lobectomy can be performed. The long-term results of surgical treatment are good, preoperative symptoms abate in most patients, and the rate of aspergillosis recurrence is very low.