Fibrinolytic agents are a useful adjunct in the management of complicated parapneumonic effusions. Intrapleural fibrinolytics, if used early in the fibrinopurulent stage of a parapneumonic effusion, decrease the rate of surgical interventions (VATS or open decortcation) and the length of hospital stay with minor associated morbidity.

Pneumonectomy is related with postoperative elevation of PASP and RV dilatation, especially right pneumonectomy. Significant percent FVC reduction, increased age and low pO2 values are the main responsible factors for elevation of the 6-month postoperative PASP values.

No abstract

This study was conducted in order to re-define the incidence and natural history of postresectional residual pleural spaces (PRS). From 1997 to 2005, 966 patients who were subjected to less than entire lung resections, were followed and any cases of PRS were recorded. The records of these patients were retrospectively analyzed for age, gender, type of resection, side, apical or basal location, size, PRS wall thickness, empyema as well as for bronchopleural fistula occurence, management, and outcome. Postresectional residual pleural spaces outcome was correlated with space characteristics. A total of 92 cases (9.5%) of PRS were documented which developed frequently ( p < 0.001) after upper lobectomies, malignant disease, at an apical location, and on the right side. Unfavorable outcome was strongly correlated with age > 70 years ( p < 0.001), air leak ( p < 0.001), empyema ( p < 0.001), and thickened pleura ( p < 0.001). Good prognosis of PRS was strongly correlated with male gender, apical location, right side, normal pleura thickness, and small size. Postresectional residual pleural spaces of small size without any associated complications should not prolong hospitalization time.

A best evidence topic was written according to a structured protocol. The question addressed was whether pulmonary resection is safe and worthwhile in patients who have undergone previous pneumonectomy. A total of 141 studies were identified using the reported search, of which 8 represented the best evidence to answer the clinical question. Studies on multiple lung cancers with patients undergoing subsequent pulmonary resection after previous pneumonectomy, without outcome data specifically for this group of patients and case reports, were not included in this analysis. The authors, date, journal, country, study type, population, outcomes and key results are tabulated. All studies were retrospective. In total, 102 patients underwent pulmonary resection after contralateral pneumonectomy, of which 96 had sublobar resections and 6 had lobectomies. Postoperative complications, reported in four of the eight studies, ranged from 21 to 44% (mean from four studies 36.8%). Four of the eight studies reported no mortality after pulmonary resection following pneumonectomy, whereas the other four reported mortality rates from 6.7 to 43%. For patients undergoing sublobar resections, the postoperative mortality was 6.2% (6/96), while for those submitted to lobectomy, mortality was 33.3% (2/6). Five-year survival rates ranged from 14% for metastatic disease to 50% for metachronous lung cancer. Due to the infrequent situation of a patient being considered for a pulmonary resection after contralateral pneumonectomy, this analysis was based on a limited number of patients from eight reports. Nevertheless, analysis of the data suggests that pulmonary resection for metastatic or metachronous disease can be performed with acceptable morbidity and low mortality in appropriately selected patients who have previously undergone a pneumonectomy. Sublobar resection is the treatment of choice whenever possible, for which long-term results are rewarding especially for patients with metachronous lung cancer.