Objective To investigate the surgical indications of pulmonary aspergilloma, and to reduce postoperative complications. MethodsA total of 160 surgically treated patients with pulmonary aspergilloma were analyzed retrospectively from September 1975 to March 2006. All patients were divided into two groups: simple pulmonary aspergilloma(SPA,n=34) and complex pulmonary aspergilloma(CPA, n=126), according to the nature and extent of the underlying disease of the lung. The operative procedures included 154 pulmonectomy, 3 thoracoplasties with pulmonectomy or filling with the muscle flap, and 3 cavernostomy filling with the muscle flap. Results 156 of 160 cases had been cured with cure rate of 97.5% and no postoperative deaths. There were postoperative complications in 44 patients(27.5%) including: pneumonia(15 cases), incomplete reexpansion(12 cases), prolonged air leak(10 cases), empyema (5 cases), pulmonary abscess(5 cases), bronchopleural fistula(3 cases) and wound infection(2 cases). Postoperative complications of SPA group were lower than those in CPA group (P＜0.05). One hundred and fifty-one patients were followed up for 4 months to 5 years, no recurrence were observed. Conclusion Surgical resection for pulmonary aspergilloma should be selected first whenever the diagnosis of aspergilloma is confirmed. Objective and reliable preoperative evaluation is the key to reducing postoperative complications and surgery success. Because of minimal invasiveness, short length of hospital stay and less postoperative complications, video-assisted minithoractomy surgery may be superior to open thoracotomy in patients with localized underlying pulmonary disease and less pleural adhesions.