To describe patient characteristics, indications for surgery, operative techniques, perioperative outcomes, and long-term results, thereby contributing local evidence to guide future surgical management in similar high-burden settings.

This retrospective study was conducted at the Department of Thoracic Surgery, Services Hospital, Lahore, Pakistan, reviewing all patients who underwent surgery for pulmonary fungal or cavitary lung diseases between January 2005 and December 2024. Of 580 patients evaluated, 415 met the inclusion criteria for surgical intervention. Data regarding demographics, comorbidities, operative details, postoperative complications, and long-term outcomes were analyzed using SPSS version 26.

Among the 415 operated patients, 271 (65.3%) were males and 144 (34.7%) females, with a mean age of 45.1 ± 13.4 years. A history of prior pulmonary tuberculosis was present in 250 patients (60.2%), hepatitis C in 183 (44%), and diabetes mellitus in 144 (34.6%). Lobectomy was the most frequently performed procedure (58.1%), followed by segmentectomy (17.3%) and cavernostomy (12.8%). The major postoperative complications included prolonged air leak (8.7%), empyema (5.3%), and bronchopleural fistula (3.4%). The overall in-hospital mortality rate was 2.4%. At follow-up, 92% of patients achieved complete cessation of hemoptysis and marked symptomatic improvement.

Surgical management of pulmonary fungal and cavitary lung diseases is safe and effective when performed in experienced centers. Despite technical challenges, especially in post-tuberculous lungs, operative intervention provides durable control of symptoms and excellent long-term outcomes with acceptable morbidity and mortality.