Empyema after pneumonectomy--empyema window or thoracoplasty?

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Surgical Infections

Background:

• Empyema, a serious complication following pneumonectomy, presents significant treatment challenges.
• Pneumonectomy, the surgical removal of an entire lung, can lead to persistent air leaks and subsequent infection.
• Bronchial carcinoma is a primary indication for pneumonectomy, increasing the risk of post-operative complications.

Purpose of the Study:

• To evaluate the effectiveness of window healing in treating empyema after pneumonectomy.
• To analyze therapeutic modalities for pneumonectomy cavity empyema.
• To assess treatment outcomes and mortality rates for this specific patient group.

Main Methods:

• Retrospective analysis of 369 pneumonectomies performed between 1981 and 1988.
• Detailed investigation of 31 empyema cases occurring after 322 pneumonectomies for bronchial carcinoma.
• Comparison of treatment outcomes, including the use of thoracic windows.

Main Results:

• A 58% cure rate (18 out of 31 patients) was observed in empyema cases post-pneumonectomy.
• Nine patients treated with a thoracic window achieved a cure.
• Hospital mortality for empyema patients after pneumonectomy was 42%.

Conclusions:

• Window healing, particularly thoracic windows, offers a viable treatment option for pneumonectomy cavity empyema.
• Despite therapeutic interventions, the management of post-pneumonectomy empyema remains associated with high mortality.
• Historical comparisons suggest a lack of significant progress in improving outcomes for this septic complication.