Resection of pulmonary aspergilloma using uniportal video-assisted thoracoscopic surgery: Evaluation of prognostic factors in a single-centre experience

INTRODUCTION: Uniportal video-assisted thoracoscopic surgery (U-VATS) is emerging as a promising approach for the treatment of pulmonary aspergilloma (PA). Nevertheless, it remains technically challenging and is associated with significant morbidity and a considerable risk of conversion to thoracotomy. This study aimed to evaluate the feasibility and safety of U-VATS in patients with PA and to identify prognostic factors that influence postoperative morbidity and conversion rates. PATIENTS AND METHODS: We retrospectively reviewed the medical records of 51 patients who underwent U-VATS resection for PA between 2017 and 2020. Patients were classified as having either simple or complex aspergilloma. Clinical, radiological and surgical variables were analysed to determine their impact on outcomes. RESULTS: Of the 51 patients, 31 were male, with a median age of 43.5 years. simple PA was present in 9 patients and complex PA (CPA) in 42. Tuberculosis was the most common underlying condition and was significantly associated with complex aspergilloma (P = 0.015). Haemoptysis was the most frequent symptom, and the upper lobes were the predominant sites of involvement. Lobectomy was performed in 74.5% of cases, and 29.4% required conversion to thoracotomy. Post-operative complications occurred in 19.6% of patients, predominantly in those with CPA. Multivariable analysis identified haemoptysis, tuberculosis, CPA, lobectomy and complete pleural adhesions as significant predictors of postoperative morbidity. Haemoptysis, tuberculosis, upper lobe location, complex CPA and pleural adhesions were independent predictors of conversion. CONCLUSION: Haemoptysis, tuberculosis, CPA and complete pleural adhesions are key prognostic factors associated with increased morbidity and higher rates of conversion in patients undergoing U-VATS for PA.