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"Vetus Sed Utilis": Open Window Thoracostomy after Lung Surgery
Antonio Mazzella1, Claudia Bardoni1, Luca Bertolaccini1
1Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
The Thoracic and Cardiovascular Surgeon
|June 5, 2025
Summary
Open window thoracostomy (OWT) is a safe and feasible surgical technique for managing chronic thoracic infections and broncho-pleural fistulas after lung surgery. This 25-year study confirms its usefulness and good quality of life outcomes in modern practice.
Area of Science:
- Thoracic Surgery
- Surgical Infectious Diseases
- Pulmonary Medicine
Background:
- Open window thoracostomy (OWT) is an established surgical procedure for chronic thoracic infections.
- Its efficacy in the modern era, particularly for complications after lung resection, requires ongoing evaluation.
Purpose of the Study:
- To assess the feasibility and usefulness of OWT over a 25-year period.
- To report outcomes for patients with chronic empyema and broncho-pleural fistula (BPF) after lung surgery.
Main Methods:
- Retrospective review of a database from 1999-2024.
- Analysis of preoperative, intraoperative, and postoperative data for 66 patients undergoing OWT.
- Data included mortality, survival, and reintervention rates for OWT closure.
Main Results:
- OWT was performed for BPF after pneumonectomy (85%) or lobectomy (12%), and chronic empyema (3%).
- 30- and 90-day mortality after OWT for pneumonectomy was 3% and 6%, respectively; no deaths in other groups.
- 22.7% of OWTs were closed with flaps; no survival difference between closed and open OWTs post-pneumonectomy.
Conclusions:
- OWT is a safe, feasible, and sometimes necessary technique for managing chronic infections and BPF post-lung surgery.
- The procedure is well-tolerated and supports an appropriate quality of life for patients.
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