Does postpneumonectomy empyema improve long-term survival for patients with lung cancer?

Postpneumonectomy empyema (PPE) is life-threatening morbidity that affects up to 10% of patients and carries a 9-13% mortality risk. Treatment can take a long time, and the prognosis is uncertain. Forty years ago, improved survival was reported among patients with lung cancer and pleural empyema compared to those with lung cancer and no empyema. Here we investigated this potential association among patients with PPE. The present study included 38 patients who underwent pneumonectomy between 1995-2007 (7 females, 31 males, median age of 62 years) and then developed PPE, which was treated with the accelerated treatment (AT) method. Thirty-five of these patients had been diagnosed with lung cancer (including one case of carcinoid with infiltration), of whom 31 were matched with 31 lung cancer patients who underwent uncomplicated pneumonectomy at the same center between 1997-2009. The two groups did not significantly differ regarding sex, age, histology, TNM, FEV1, major co-morbidities, or received neoadjuvant or adjuvant therapy. Thirty-five (92.1%) patients from the initial group were treated successfully and the 5- and 10-year survival rates were 69% and 51%, respectively. Comparison between the matched groups revealed longer survival rates in the empyema group (5-year, 70%; 10-year, 49%) compared to the group without empyema (5-year, 38%; 10-year, 18%). Compared to the group without empyema, the empyema group showed significantly longer survival for all-cause mortality (p=0.004) and a lower incidence of cancer-unrelated mortality (p=0.02). The two groups did not significantly differ with regard to cancer-related mortality (p=0.09). In conclusion, accelerated treatment is a safe and effective method for the treatment of pleural empyema after pneumonectomy. The presently achieved results indicate improvement in survival of lung cancer patients with PPE in comparison to lung cancer patients after uncomplicated pneumonectomy.