Purpose: Surgical treatment for pulmonary aspergillosis remains technically demanding because of dense pleural adhesions, chronic inflammation, and the risk of major bleeding. We evaluated temporal changes in patient characteristics, perioperative management, and surgical outcomes over a 30-year period at a single institution. Methods: We retrospectively reviewed 57 consecutive patients who underwent surgery for pulmonary aspergillosis between 1992 and 2023. Patients were divided into an early era (1992-2007, n = 23) and a late era (2008-2023, n = 34). Clinicopathological characteristics, operative variables, perioperative management, and postoperative outcomes were compared. Results: Hemoptysis or bloody sputum and previous pulmonary tuberculosis were significantly less frequent in the late era. Lobectomy was the most common procedure, while video-assisted thoracoscopic surgery was introduced during the later period. Operative time (350 vs. 250 min, p = 0.016) and median blood loss (750 vs. 178 mL, p = 0.003) were significantly reduced in the late era. However, the incidence of major postoperative complications and overall survival did not differ significantly between the 2 eras. Conclusion: Surgical management of pulmonary aspergillosis has evolved with improvements in operative efficiency and blood loss while maintaining acceptable perioperative and long-term outcomes. Careful patient selection and multidisciplinary perioperative management remain essential, particularly for patients with chronic pulmonary aspergillosis.
