[Purulent pleurisy and lung cancer. Non-iatrogenic forms and therapeutic management]

Thoracic empyemas may occur during the course of lung cancer as a post-thoracotomy complication, or after pleural drainage and/or chemotherapy in cases when surgery was unfeasible, or may complicate the natural history of the disease and appear as the clinical event that led to its discovery. This latter situation is a challenge requiring to cure the infection in order to further treat the underlying lung cancer. We reviewed the cases of 18 men aged between 46 and 79 years that were referred to our surgical department from 1984 to 1996 for management of a thoracic empyema with an underlying lung cancer. Initial presentation of empyemas, lung tumor characteristics, treatments performed and their results were analyzed so as to formulate guidelines if possible. Mean duration of 17 empyemas before arrival was 26 days (8 to 60 days) and in one case empyema occurred during diagnostic work-up of an excavated lesion. Frank pus was observed in all cases and micro-organisms were identified in 13 cases. Empyema and diagnosis of lung cancer were concomitant in 15 cases: in 3 cases lung neoplasia was already diagnosed but patients had refused surgery. Empyema was treated by under water-seal chest tube drainage with adjunct fibrinolytic therapy in all cases; 2 elderly and cachectic patients suffering metastatic diffusion died rapidly. The other 16 recovered within one month. In 7 cases management was limited to medical treatment (palliative n = 2, chemotherapy n = 1, chemo combined radiotherapy n = 2 and radiotherapy alone n = 2) but only short survivals were observed (inferior to 10 months). Surgery was possible in 9 (pneumonectomy n = 8, lobectomy n = 1); there was no death; postsurgical empyemas complicated the cause twice but were easily cured by drainage; long term survivals were observed in 3 cases that were p NO. Pleural empyema complicating lung cancer is a rare but challenging situation. Once the pleural empyema has been controlled, surgical resection must be performed when indicated: postoperative complications are rare and long-term survival is possible.