Further observation on empyema after resection of bronchogenic carcinoma and survival

Out of 11,247 cases undergoing resectional therapy for bronchogenic carcinoma at 39 institutions, 6,348 were operated before July 1976 and the remaining 4,899 thereafter. Analyzing both series, the following results were obtained: 1) The rate of pneumonectomies to lobectomies was 1:2.3 in the former and 1:3.9 in the latter. Pneumonectomies were more on the left side, whereas the right lobectomies were about twice as many as the left ones. 2) Postoperative empyema occurred in 180 cases (2.8%) in the former and 79 cases (1.6%) in the latter. The incidence was significantly higher in the cases of right pneumonectomy than in the cases of left pneumonectomy, and in the cases of pneumonectomy than in the cases of lobectomy. Although the incidence of postpneumonectomic empyema decreased only slightly, overall incidence decreased significantly because of marked increase of lobectomy cases. 3) Out of 180 cases of empyema in the former series, 17 died within 30 days. 4) The 5-year survival rate of the patients with empyema was 28 per cent. 5) The 5-year survival rate was 30 per cent in 93 cases of squamous cell carcinoma, 30 per cent in 50 cases of adenocarcinoma and 15 per cent in 13 cases of large cell carcinoma. There was no survivor among 7 cases of small cell carcinoma. 6) Out of 259 cases of empyema, micro-organisms were cultured in 161 cases, were negative in 20, and unknown in 78. Although various organisms were found, gram-negative bacteria and Pseudomonas were most frequently isolated, i.e. 37 per cent and 36 per cent, respectively. 7) As for the treatment of 5-year survival cases of empyema, thoracoplasty and bronchial closure were frequent as compared with open thoracic window technics such as Eloesser's and Symbas' operation. And, more than half of the cases of empyema seem to have been complicated with bronchial fistulae.