OBJECTIVE Pneumonectomy for complex aspergilloma is associated with high morbidity rates. This study aimed to improve the outcomes of this high-risk procedure by preventing postoperative complications. METHODS Between April 1999 and December 2004, 25 patients underwent pulmonary resection for complex aspergilloma at our institution. Of these patients, 11 (44%) patients (9 males and 2 females) undergoing a pneumonectomy were reviewed in this study. Median age was 63 years (range, 36-71 years). Associated pulmonary diseases were cavities secondary to tuberculosis (n=6) and a post-lobectomy destroyed lung (n=5). All patients presented with symptoms, including hemoptysis (n=10) and purulent sputum (n=1). To minimize the risk of empyema and bronchopleural fistula, careful extrapleural dissection and bronchial stump reinforcement with a latissimus dorsi muscle flap were employed in all patients. Follow-up was completed on March 31, 2005. RESULTS We performed six pneumonectomies (two right and four left) and five completion pneumonectomies (one right and four left). Operating time ranged from 361 to 781 min (median, 432 min). The median intraoperative blood loss was 1050 ml (range, 200-2910 ml). There was no operative mortality. No patient required re-exploration for postoperative hemorrhage. The major complications were empyema caused by anaerobic bacteria (n=1) and chylothorax (n=1). The treatment of both complications was successful. All patients were free from aspergillosis at the time of follow-up. CONCLUSIONS Pneumonectomy for symptomatic complex aspergilloma can be performed with no mortality and low morbidity. The favorable results of this potentially deleterious procedure hinge on the efforts to prevent postoperative complications.