The surgical treatment of stage III empyema: the effect on lung function

The aim of this study was to evaluate the surgical treatment of stage III empyema.

Between 2002 and 2005, 30 patients underwent surgery for treatment of diagnosed stage III empyema preoperatively. Patients were referred for spirometry to evaluate lung function postoperatively.

Twenty nine patients underwent primary thoracotomy because of an extended stage III empyema, 1 patient video-assisted thoracoscopic surgery (VATS). Mean age was 62 years. Mean period from onset of symptoms until hospital admission was 29 days and mean time interval between admission and surgery was 11 days. Intraoperative complication happened in one patient (3%), in whom a phrenic nerve lesion was diagnosed. Overall mortality rate was 3%. In 17 patients postoperative spirometry was performed, showing normal vital capacity in 59% of the patients.

There was no reluctance in performing primary thoracotomy in our population with a stage III empyema. Decortication by means of thoracotomy restored the complete expansion of the lung; the authors claim that vital capacity returned to normal values, as it was shown by the spirometry results postoperatively. Early referral to the respiratory department in case of a non-responding pneumonia and early surgical consultation in case of a parapneumonic effusion, will prevent progression to an extensive organized stage III empyema requiring decortication by thoracotomy.