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Early and delayed post-pneumonectomy empyemas: Microbiology, management and prognosis

Jean-Baptiste Stern1, Ludovic Fournel2, Benjamin Wyplosz3

  • 1Pulmonary Unit, Institut du Thorax, Institut Mutualiste Montsouris, Paris, France.

The Clinical Respiratory Journal
|November 9, 2017
PubMed
Abstract

Insights

Post-pneumonectomy empyema (PPE) has two distinct presentations: early, often polymicrobial, and late, usually monomicrobial. Early PPE is linked to significantly higher mortality rates compared to delayed cases.

Area of Science:

  • Thoracic Surgery
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Post-pneumonectomy empyema (PPE) is a severe complication following pneumonectomy.
  • Understanding the microbiology and its impact on management and prognosis is crucial.

Purpose of the Study:

  • To investigate the microbiology, management strategies, and prognosis of post-pneumonectomy empyema.
  • To differentiate between early and delayed PPE and their associated outcomes.

Main Methods:

  • Retrospective review of 37 consecutive patients with PPE over 10 years.
  • Analysis of microbiological data, treatment modalities, and patient outcomes.
  • Comparison of early (<14 days) versus delayed (>16 days) PPE.

Main Results:

  • Early PPE (n=17) was more frequently polymicrobial (65%) than delayed PPE (n=20, 25%), with Gram-negative bacteria noted.
  • Video-assisted thoracoscopic surgery (VATS) for lavage was successful in 59% of cases without bronchopleural fistula (BPF).
  • Overall 90-day mortality was 19%, with significantly higher mortality in the early PPE group (35% vs 5% for delayed PPE).

Conclusions:

  • Two distinct PPE presentations exist: early (polymicrobial, high mortality) and delayed (monomicrobial, better prognosis).
  • VATS is effective for PPE management in the absence of BPF, though secondary thoracostomy may be required.
  • Early post-pneumonectomy empyema significantly increases mortality risk.
Keywords:
empyemalung cancerpneumonectomysurvival analysisthoracoscopy/VATS

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