Postoperative Empyema After Pleurectomy Decortication for Malignant Pleural Mesothelioma

Postoperative empyema after pleurectomy decortication (PDC) for malignant pleural mesothelioma (MPM) is a serious complication that necessitates prolonged hospitalization. This study determined the incidence, risk factors, and prognosis in patients when postoperative empyema develops after PDC.

The background, type of PDC, neoadjuvant treatment, date of empyema, pleural fluid cultures, treatment after empyema, and prognosis from a series of consecutive 355 patients treated over 9 years at a single high-volume center were investigated. Fisher exact test, Kaplan-Meier estimators, and log-rank test were used to identify significant risk factors for postoperative empyema and compare the overall survival.

During the 9-year period, 355 patients (263 men) underwent PDC for MPM at a median age of 69 years. Neoadjuvant therapy was given to 87, and 282 received intraoperative heated chemotherapy. During the study, empyema developed in 24 patients (6.8%). The length of stay of patients with postoperative empyema was significantly longer. Median survival was 11.7 months for patients with postoperative empyema and 21.3 months for patients without empyema (hazard ratio, 1.78; P = .009). Postoperative empyema was associated with male sex, prolonged air leak, and use of prosthetic mesh.

Postoperative empyema after PDC is associated with prolonged length of stay and higher mortality. The rates of this serious postoperative complication might decrease by developing better strategies to avoid prolonged air leak after PDC.